1st Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece.
Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA.
CNS Neurol Disord Drug Targets. 2024;23(11):1320-1327. doi: 10.2174/0118715273270503230928100141.
Aneurysmal subarachnoid hemorrhage (aSAH) is a type of non-traumatic SAH that can have detrimental effects on the central nervous system, resulting in severe disability or death.
Early nimodipine is currently the only strongly recommended pharmacological treatment that has shown efficacy in improving neurological/functional outcomes in aSAH patients. Whether statin treatment is of benefit to aSAH patients is an issue that has generated considerable interest and debate. In the present scoping review, we mapped and analyzed the available literature on metaanalyses of randomized clinical trials (RCTs) examining the effect of statins on aSAH. Seventeen meta-analyses of RCTs, published between 2008 and 2023, were identified.
Treatments in included meta-analyses were based on various regimens of simvastatin, pravastatin, pitavastatin or atorvastatin for up to 21 days. Eleven of the included reports indicated some beneficial effect of statin treatment, reducing rates of at least one of the following: cerebral vasospasm, delayed cerebral ischemia/delayed ischemic neurologic deficit, mortality or functional/ neurological outcome. In contrast, six meta-analyses, showed no such effects.
The limitations reported by several meta-analyses, included low patient numbers or disproportionate representation of patients from certain RCTs, differences in drug treatment, patient diagnostic criteria and outcome evaluation between RCTs, as well as poor data quality or lack of RCTs data. Knowledge of the reported limitations may aid the design of future clinical trials and/or their meta-analyses.
动脉瘤性蛛网膜下腔出血（aSAH）是一种非创伤性的蛛网膜下腔出血，可对中枢神经系统造成损害，导致严重残疾或死亡。
目前，早期尼莫地平是唯一被强烈推荐的药物治疗方法，已被证明能改善 aSAH 患者的神经/功能预后。他汀类药物治疗是否对 aSAH 患者有益是一个引起广泛关注和争议的问题。在本范围综述中，我们对现有的他汀类药物治疗 aSAH 的随机临床试验（RCT）荟萃分析文献进行了映射和分析。共确定了 2008 年至 2023 年间发表的 17 项 RCT 的荟萃分析。
纳入荟萃分析的治疗方法基于辛伐他汀、普伐他汀、匹伐他汀或阿托伐他汀的各种方案，治疗时间长达 21 天。纳入的 11 份报告表明他汀类药物治疗有一定的益处，降低了以下至少一种情况的发生率：脑血管痉挛、迟发性脑缺血/迟发性缺血性神经功能缺损、死亡率或功能/神经预后。相比之下，有 6 项荟萃分析没有显示出这种效果。
几项荟萃分析报告的局限性包括患者数量较少或某些 RCT 患者代表性不均衡、药物治疗、患者诊断标准和 RCT 之间的结果评估存在差异，以及数据质量差或缺乏 RCT 数据。了解报告的局限性可能有助于设计未来的临床试验和/或荟萃分析。
