Zaryczańska Karolina, Pawlukowska Wioletta, Nowacki Przemysław, Zwarzany Łukasz, Bagińska Ewelina, Kot Monika, Masztalewicz Marta
Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland.
Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, 71-252 Szczecin, Poland.
J Clin Med. 2023 Oct 19;12(20):6608. doi: 10.3390/jcm12206608.
The neuroprotective effect of statins has become a focus of interest in spontaneous intracerebral hemorrhage (sICH). The purpose of this study was: (1) to evaluate the effect of statin use by the analyzed patients with sICH in the period preceding the onset of hemorrhage on their baseline neurological status and baseline neuroimaging of the head; (2) to evaluate the effect of statin use in the acute period of hemorrhage on the course and prognosis in the in-hospital period, taking into account whether the statin was taken before the hemorrhage or only after its onset; (3) to evaluate the effect of continuing statin treatment after in-hospital treatment on the functional performance and survival of patients up to 90 days after the onset of sICH symptoms, taking into account whether the statin was taken before the onset of sICH.
A total of 153 patients diagnosed with sICH were analyzed, where group I were not previously taking a statin and group II were taking a statin before sICH onset. After lipidogram assessment, group I was divided into patients without dyslipidemia and without statin treatment (Ia) and patients with dyslipidemia who received de novo statin treatment during hospitalization (Ib). Group II patients continued taking statin therapy. We evaluated the effect of prior statin use on the severity of hemorrhage; the effect of statin use during the acute period of sICH on its in-hospital course; and the effect of statin treatment on the severity of neurological deficit, functional capacity and survival of patients up to 90 days after the onset of sICH symptoms.
There was no effect of prior statin use on the severity of hemorrhage as assessed clinically and by neuroimaging of the head. At in-hospital follow-up, subgroup Ia was the least favorable in terms of National Institutes of Health Stroke Scale (NIHSS) score. This subgroup had the highest percentage of deaths during hospitalization. In the post-hospital period, the greatest number of patients with improvement in the NIHSS, modified Rankin Scale (mRS) and Barthel scales were among those taking statins, especially group II patients. At 90-day follow-up, survival analysis fell significantly in favor of subgroup Ib and group II.
他汀类药物的神经保护作用已成为自发性脑出血（sICH）研究的一个热点。本研究的目的是：（1）评估分析的sICH患者在出血发作前使用他汀类药物对其基线神经状态和头部基线神经影像学的影响；（2）考虑他汀类药物是在出血前还是仅在出血发作后使用，评估出血急性期使用他汀类药物对住院期间病程和预后的影响；（3）考虑sICH症状发作前是否使用他汀类药物，评估住院治疗后继续使用他汀类药物治疗对sICH症状发作后90天内患者功能表现和生存的影响。
共分析了153例诊断为sICH的患者，其中I组患者之前未服用他汀类药物，II组患者在sICH发作前服用他汀类药物。在进行血脂谱评估后，I组被分为无血脂异常且未接受他汀类药物治疗的患者（Ia）和住院期间接受他汀类药物初始治疗的血脂异常患者（Ib）。II组患者继续服用他汀类药物治疗。我们评估了先前使用他汀类药物对出血严重程度的影响；sICH急性期使用他汀类药物对其住院病程的影响；以及他汀类药物治疗对sICH症状发作后90天内患者神经功能缺损严重程度、功能能力和生存的影响。
临床评估和头部神经影像学评估显示，先前使用他汀类药物对出血严重程度没有影响。在住院随访中，就美国国立卫生研究院卒中量表（NIHSS）评分而言，Ia亚组情况最不理想。该亚组住院期间的死亡百分比最高。在出院后时期，NIHSS、改良Rankin量表（mRS）和Barthel量表改善的患者中，服用他汀类药物的患者数量最多，尤其是II组患者。在90天随访时，生存分析结果明显有利于Ib亚组和II组。
