Mele Chiara, Maggioni Giorgio, Giordano Andrea, Lunardon Clara, Balsamo Francesca, Mazzone Alessandra, Pistarini Caterina
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Neurorehabilitation Division, Istituti Clinici Scientifici Maugeri SPA SB, Institute of Veruno, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Novara, Italy.
Front Neurol. 2021 Oct 21;12:744732. doi: 10.3389/fneur.2021.744732. eCollection 2021.
Statins exert pleiotropic effects by influencing several mechanisms, including synaptogenesis, neurogenesis, cerebral flow regulation, and angiogenesis. Results from and animal models suggest that statins could have beneficial effect on functional recovery and outcome after stroke events. However, results in human studies are still controversial. The aim of our study was to evaluate the role of statin in influencing functional outcome and subsequent clinical follow-up in a large cohort of post-stroke rehabilitation patients. This retrospective study consecutively enrolled 413 adult patients with stroke event, admitted to the division of Neurorehabilitation of the IRCCS ICS Maugeri, Veruno (Italy), for an individual rehabilitation program between 2015 and 2017. Follow-up lasted 3-5 years after discharge. Demographic data, etiology, classification, and anatomical site of stroke lesion, functional assessment, use and duration of statin therapy, and death during hospitalization were collected at baseline and on discharge. Clinical data on subsequent follow-up were also evaluated, considering these as variables: stroke recurrence, bone fractures, cardiovascular complications, and death. In our cohort, 177 patients (42.9%) were prescribed statin therapy, of whom 50 (28.2%) before the stroke event and 127 (71.8%) at the beginning of the rehabilitation process. The use and type of statin therapy as well as the duration of treatment were not associated with recovery and functional outcome, regardless of confounders including sex, age, etiology, and site of stroke lesion, and initial functional level. For what concern post-discharge clinical follow-up, the use of statin therapy was significantly associated with a lower risk of bone fractures (OR = 0.095, CI 95%: 0.012-0.743, = 0.01) independently from age, sex, initial and final functional level, and comorbidities. The use of statins does not seem to influence the functional outcome in post-stroke patients. However, they could exert a protective role against bone fractures during post-discharge follow-up, suggesting further evaluation on this topic.
他汀类药物通过影响多种机制发挥多效性作用，包括突触形成、神经发生、脑血流调节和血管生成。细胞实验和动物模型的结果表明，他汀类药物可能对中风事件后的功能恢复和预后有有益影响。然而，人体研究的结果仍存在争议。我们研究的目的是评估他汀类药物在一大群中风后康复患者中对功能预后及后续临床随访的影响。这项回顾性研究连续纳入了413例中风患者，这些患者于2015年至2017年期间入住意大利韦鲁诺市IRCCS ICS Maugeri神经康复科，接受个体化康复治疗。出院后随访持续3至5年。在基线和出院时收集人口统计学数据、病因、中风病变的分类和解剖部位、功能评估、他汀类药物治疗的使用情况和持续时间以及住院期间的死亡情况。还评估了后续随访的临床数据，将这些作为变量：中风复发、骨折、心血管并发症和死亡。在我们的队列中，177例患者（42.9%）接受了他汀类药物治疗，其中50例（28.2%）在中风事件前，127例（71.8%）在康复过程开始时。无论包括性别、年龄、病因、中风病变部位和初始功能水平在内的混杂因素如何，他汀类药物治疗的使用和类型以及治疗持续时间均与恢复和功能预后无关。关于出院后的临床随访，他汀类药物治疗的使用与较低的骨折风险显著相关（OR = 0.095，95%CI：0.012 - 0.743，P = 0.01），独立于年龄、性别、初始和最终功能水平以及合并症。他汀类药物的使用似乎不影响中风后患者的功能预后。然而，它们可能在出院后随访期间对骨折起到保护作用，提示对该主题进行进一步评估。
