Susanto Martin, Pangihutan Siahaan Andre Marolop, Wirjomartani Beny Atmadja, Setiawan Hendy, Aryanti Citra
Faculty of Medicine, University of Sumatera Utara, Medan, North Sumatra, Indonesia.
Department of Neurosurgery, University of Sumatera Utara, Medan, North Sumatra, Indonesia.
World Neurosurg X. 2023 May 13;19:100211. doi: 10.1016/j.wnsx.2023.100211. eCollection 2023 Jul.
Despite recent encouraging pharmaceutical and technical breakthroughs in neurosurgical critical care, traumatic brain injury (TBI)-related mortality and morbidity remain substantial clinical issues. Medication of statins was revealed to enhance outcomes following TBI in animal research. In addition to their main role of decreasing serum cholesterol, statins decrease inflammation and enhance cerebral blood flow. However, research on the efficacy of statins in TBI is still limited. This systematic review was conducted to determine the efficacy of statins in enhancing the clinical outcomes of TBI individuals, and specifically investigate the optimal dose and form of statins. The databases of PubMed, DOAJ, EBSCO, and Cochrane were extensively researched. The date of publication within the last fifteen years was the inclusion criterion. Meta-analyses, clinical trials, and randomized controlled trials were prioritized forms of research publications. Ambiguous remarks, irrelevant correlations to the main issue, or a focus on disorders other than TBI were the exclusion criteria. Thirteen research were included in this study. Simvastatin, atorvastatin, and rosuvastatin were the main form of statins discussed in this study. Enhancement of the Glasgow Coma Scale, survival rates, hospital length of stay, and cognitive outcomes were revealed in this study. This study suggests either simvastatin 40 mg, atorvastatin 20 mg, or rosuvastatin 20 mg for 10 days as the optimal therapeutic forms and doses to be applied in the management of TBI. Pre-TBI statin use was linked to lower risk of mortality in TBI individuals compared to nonusers, whereas statin discontinuation was linked to an increase in mortality.
尽管最近神经外科重症监护在药物和技术方面取得了令人鼓舞的突破,但创伤性脑损伤(TBI)相关的死亡率和发病率仍然是重大的临床问题。动物研究表明,他汀类药物治疗可改善TBI后的预后。除了降低血清胆固醇的主要作用外,他汀类药物还可减轻炎症并增加脑血流量。然而,他汀类药物在TBI中的疗效研究仍然有限。本系统评价旨在确定他汀类药物在改善TBI患者临床结局方面的疗效,并具体研究他汀类药物的最佳剂量和剂型。对PubMed、DOAJ、EBSCO和Cochrane数据库进行了广泛检索。纳入标准为过去十五年内发表的文献。优先选择的研究发表形式为荟萃分析、临床试验和随机对照试验。排除标准为表述模糊、与主要问题无关的关联或关注TBI以外的疾病。本研究纳入了13项研究。辛伐他汀、阿托伐他汀和瑞舒伐他汀是本研究中讨论的主要他汀类药物剂型。本研究显示格拉斯哥昏迷量表评分、生存率、住院时间和认知结局均有所改善。本研究表明,辛伐他汀40mg、阿托伐他汀20mg或瑞舒伐他汀20mg,持续10天,是TBI治疗中最佳的治疗剂型和剂量。与未使用他汀类药物的TBI患者相比,TBI患者在受伤前使用他汀类药物与较低的死亡风险相关,而停用他汀类药物则与死亡率增加相关。