卒中前他汀类药物通过增加细胞因子信号转导抑制因子 3 水平改善房颤相关性卒中的预后。

Department of Neurology, Chengdu Second People's Hospital, Chengdu, China,

Department of Neurology, Nanchong Central Hospital, Nanchong, China.

Eur Neurol. 2021;84(2):96-102. doi: 10.1159/000513767. Epub 2021 Mar 8.

BACKGROUND

Cerebral infarction associated with atrial fibrillation (AF) has relatively higher mortality and morbidity rates than other types of stroke. Statins are being commonly prescribed to patients with stoke. However, the use of statins in AF-related stroke, especially prestroke, has not been well studied. This study aimed to investigate whether the use of prestroke statins could improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS) and its mechanism.

METHODS

This prospective study enrolled 453 AF-associated AIS patients from 4 medical centers and divided them into 2 groups based on the statin use before the stroke episode. All patients received comprehensive clinical examinations including 72-h Holter electrocardiogram monitoring and were followed up for 3 months. Plasma suppressor of cytokine signaling-3 (SOCS-3) and matrix metalloproteinase-9 (MMP-9) levels were measured by ELISA on admission and days 3 and 7 after enrollment. The endpoints were death, major disability (modified Rankin Scale score ≥3), and composite outcome (death/major disability) at 3 months after the AIS episode.

RESULTS

Plasma SOCS-3 levels were significantly increased and MMP-9 levels decreased in patients in the prestroke statin group on hospital admission and days 3 and 7 after enrollment (p < 0.001). Furthermore, our data suggested that baseline plasma SOCS-3 levels were associated with increased risk of 3-month mortality (adjusted odds ratio [OR], 1.012; 95% confidence interval [CI], 1.006-1.018; p < 0.001) and major disability (adjusted OR, 1.013; 95% CI, 1.007-1.02; p < 0.001). Similarly, baseline plasma MMP-9 levels were also associated with increased risk of 3-month mortality (adjusted OR, 1.037; 95% CI, 1.022-1.053; p < 0.001) and major disability (adjusted OR, 1.038; 95% CI, 1.022-1.55; p < 0.001).

CONCLUSION

Our data suggested that the prestroke use of statins improved the clinical outcomes in AIS patients with AF by upregulating the level of SOCS-3 and reducing the plasma MMP-9 level.

背景

与心房颤动（AF）相关的脑梗死比其他类型的中风具有更高的死亡率和发病率。他汀类药物通常被开给中风患者。然而，他汀类药物在 AF 相关中风中的应用，特别是在中风前，尚未得到很好的研究。本研究旨在探讨中风前使用他汀类药物是否可以改善 AF 相关急性缺血性中风（AIS）患者的临床结局及其机制。

方法

本前瞻性研究纳入了来自 4 家医疗机构的 453 例 AF 相关 AIS 患者，并根据中风发作前是否使用他汀类药物将他们分为 2 组。所有患者均接受了全面的临床检查，包括 72 小时动态心电图监测，并在入组后 3 个月进行随访。入院时和入组后第 3 天和第 7 天通过 ELISA 测定血浆抑制细胞因子信号转导 3（SOCS-3）和基质金属蛋白酶 9（MMP-9）水平。终点为中风发作后 3 个月的死亡、主要残疾（改良 Rankin 量表评分≥3）和复合结局（死亡/主要残疾）。

结果

中风前使用他汀类药物组患者入院时及入组后第 3 天和第 7 天的 SOCS-3 水平明显升高，MMP-9 水平降低（p<0.001）。此外，我们的数据表明，基线时 SOCS-3 水平与 3 个月死亡率（校正比值比[OR]，1.012；95%置信区间[CI]，1.006-1.018；p<0.001）和主要残疾（校正 OR，1.013；95%CI，1.007-1.02；p<0.001）的风险增加相关。同样，基线时的 MMP-9 水平也与 3 个月死亡率（校正 OR，1.037；95%CI，1.022-1.053；p<0.001）和主要残疾（校正 OR，1.038；95%CI，1.022-1.55；p<0.001）的风险增加相关。