Affiliated Hospital of Youjiang Medical University for Nationalities, Youjiang District, Baise, Guangxi, China.
Affiliated Liutie Central Hospital of Guangxi Medical University, Liunan District, Liuzhou, Guangxi, China.
Clin Neurol Neurosurg. 2023 Sep;232:107900. doi: 10.1016/j.clineuro.2023.107900. Epub 2023 Jul 17.
Statins could elevate hepatic transaminase in ischemic stroke patients. There needed to be more evidence on which method stopped statins or adjusting the dose of statins was better for patients. And no evidence showed which way more suit for some patients.
We collected ischaemic stroke patients with elevated hepatic transaminase when they take statins. The outcome was a recurrent stroke rate, transaminase value after stopping or adjusted, mortality, and favorable functional outcome (FFO). We compare outcome events between the stopped group and the adjustment group. We grouped all patients by unsupervised machine learning and analyzed data characters by the different groups.
The patients stopping statins had a higher stroke recurrence and rate of FFO (mRS 0-2), a lower mean value of transaminase, and mortality. By difference unsupervised machine learning group, the km2 group had the lowest stroke recurrence (p = 0.046), lowest mortality (p = 0.049), and highest FFO (p = 0.023). The patients of the km2 group were younger (p < 0.001), more male (p < 0.001), had lesser National Institutes of Health Stroke Scale (NIHSS) scores (p < 0.001), and had slightly higher values of blood pressure (p = 0.002). The group of unsupervised machine learning could improve models' performance.
For ischemic patients with elevated hepatic transaminase, stopping statins temporarily was a better choice of treatment strategy. These patients who were younger, male, with a lesser NIHSS score at admission and a slightly higher blood lipid value at admission, could have had a better prognosis.
他汀类药物可使缺血性脑卒中患者的肝转氨酶升高。需要更多的证据来证明停止他汀类药物或调整他汀类药物剂量对患者更有利。并且没有证据表明哪种方法更适合某些患者。
我们收集了正在服用他汀类药物且肝转氨酶升高的缺血性脑卒中患者。主要转归为复发性脑卒中发生率、停止或调整后转氨酶值、死亡率和良好的功能结局(FFO)。我们比较了停止组和调整组的转归事件。我们通过无监督机器学习对所有患者进行分组,并通过不同组分析数据特征。
停止他汀类药物治疗的患者脑卒中复发率和 FFO(mRS 0-2)更高,转氨酶均值更低,死亡率更低。通过无监督机器学习分组,km2 组脑卒中复发率最低(p=0.046),死亡率最低(p=0.049),FFO 最高(p=0.023)。km2 组患者年龄更小(p<0.001),男性更多(p<0.001),NIHSS 评分更低(p<0.001),血压值略高(p=0.002)。无监督机器学习组可改善模型的性能。
对于肝转氨酶升高的缺血性脑卒中患者,暂时停止他汀类药物治疗是一种更好的治疗策略。这些患者年龄较小、男性、入院时 NIHSS 评分较低、入院时血脂值略高,可能预后较好。