Liu Tao, Zhong Shiyu, Zhai Qingqing, Zhang Xudong, Jing Huiquan, Li Kunhang, Liu Shengyu, Han Shuo, Li Lishuai, Shi Xin, Bao Yijun
Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.
School of Management, Shanghai University, Shanghai, China.
Front Neurosci. 2021 Oct 25;15:757505. doi: 10.3389/fnins.2021.757505. eCollection 2021.
Statins are used in clinical practice to prevent from complications such as cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (aSAH). However, the efficacy and safety of statins are still controversial due to insufficient evidence from randomized controlled trials and inconsistent results of the existing studies. This meta-analysis aimed to systematically review the latest evidence on the time window and complications of statins in aSAH. The randomized controlled trials in the databases of The Cochrane Library, PubMed, Web of Science, Embase, CNKI, and Wanfang from January 2005 to April 2021 were searched and analyzed systematically. Data analysis was performed using Stata version 16.0. The fixed-effects model (M-H method) with effect size risk ratio (RR) was used for subgroups with homogeneity, and the random-effects model (D-L method) with effect size odds ratio (OR) was used for subgroups with heterogeneity. The primary outcomes were poor neurological prognosis and all-cause mortality, and the secondary outcomes were cerebral vasospasm (CVS) and statin-related complications. This study was registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42021247376). Nine studies comprising 1,464 patients were included. The Jadad score of the patients was 5-7. Meta-analysis showed that poor neurological prognosis was reduced in patients who took oral statins for 14 days (RR, 0.73 [0.55-0.97]; = 0%). Surprisingly, the continuous use of statins for 21 days had no significant effect on neurological prognosis (RR, 1.04 [0.89-1.23]; = 17%). Statins reduced CVS (OR, 0.51 [0.36-0.71]; = 0%) but increased bacteremia (OR, 1.38 [1.01-1.89]; = 0%). In conclusion, a short treatment course of statins over 2 weeks may improve neurological prognosis. Statins were associated with reduced CVS. Based on the pathophysiological characteristics of CVS and the evaluation of prognosis, 2 weeks could be the optimal time window for statin treatment in aSAH, although bacteremia may increase.
他汀类药物在临床实践中用于预防动脉瘤性蛛网膜下腔出血（aSAH）后的并发症，如脑血管痉挛（CVS）。然而，由于随机对照试验证据不足以及现有研究结果不一致，他汀类药物的疗效和安全性仍存在争议。本荟萃分析旨在系统评价他汀类药物在aSAH中的时间窗和并发症的最新证据。对2005年1月至2021年4月期间Cochrane图书馆、PubMed、Web of Science、Embase、CNKI和万方数据库中的随机对照试验进行了系统检索和分析。使用Stata 16.0进行数据分析。效应量为风险比（RR）的固定效应模型（M-H法）用于具有同质性的亚组，效应量为比值比（OR）的随机效应模型（D-L法）用于具有异质性的亚组。主要结局为神经功能预后不良和全因死亡率，次要结局为脑血管痉挛（CVS）和他汀类药物相关并发症。本研究已在PROSPERO（国际系统评价前瞻性注册库；CRD42021247376）注册。纳入了9项研究，共1464例患者。患者的Jadad评分为5 - 7分。荟萃分析表明，口服他汀类药物14天的患者神经功能预后不良有所降低（RR，0.73 [0.55 - 0.97]；I² = 0%）。令人惊讶的是，连续使用他汀类药物21天对神经功能预后无显著影响（RR，1.04 [0.89 - 1.23]；I² = 17%）。他汀类药物可降低CVS（OR，0.51 [0.36 - 0.71]；I² = 0%），但会增加菌血症（OR，1.38 [1.01 - 1.89]；I² = 0%）。总之，他汀类药物2周以上的短疗程治疗可能改善神经功能预后。他汀类药物与CVS减少有关。基于CVS的病理生理特征和预后评估，2周可能是aSAH中他汀类药物治疗的最佳时间窗，尽管可能会增加菌血症。
