阿托伐他汀对急性缺血性卒中梗死体积的影响

耿介立; 邵蓓丽; 李焰生; 徐群; 施国文; 林岩; 孙亚蒙; 陈莺

doi:10.13201/j.issn.1009-5918.2012.04.023

阿托伐他汀对急性缺血性卒中梗死体积的影响

- 上海交通大学医学院附属仁济医院神经科(上海, 200127)
基金项目:
中华医学会临床医学科研专项资金-动脉粥样硬化研究资金立项课题（No：09010360191）

详细信息

通讯作者: 李焰生,E-mail:lliyans@hotmail.com

中图分类号: R743.3

收稿日期: 2011-12-18

Impact of atorvastatin on infarct volume of acuteischemic stroke statinnaive

- Department of Neurology, Renji Hospital, Shanghai Jiaotong University, Shanghai, 200127, China

More Information

Corresponding author: LI Yansheng, E-mail: lliyans@hotmail.com

Received Date: 18 December 2011

摘要

摘要: 目的：探讨他汀在缺血性卒中急性期对梗死体积的影响。方法：前瞻性的纳入24 h内急诊入院的急性缺血性卒中患者，随机分成他汀组（40 mg/d，2周）和对照组。发病1周内，进行头颅磁共振（MRI）检查，并在3个月随访时予以复查，分析两组患者梗死体积变化的情况，并采用Logistic回归分析影响梗死体积变化的因素。同时进行血脂、炎症因子和神经功能评分等评估。结果：共39例患者接受了2次头颅MRI检查。其中阿托伐他汀组患者20例，对照组患者19例。两组患者的梗死体积变化率差异有统计学意义（P<0.01）。阿托伐他汀组患者发病后3个月梗死体积较发病时减少的比例显著高于对照组（71.4%对28.6%，P<0.05）。多因素Logistic回归分析，显示不用他汀治疗以及入院时NIHSS评分高是梗死体积增大的独立危险因素。结论：缺血性卒中急性期使用他汀可能有利于患者梗死体积的局限。梗死体积的变化可能成为临床神经功能改善的一个补充观察指标来进一步评价药物干预的效果。他汀类药物是否能局限脑梗死体积和改善临床预后仍需进一步临床研究证实。
- 缺血性卒中 /
- 他汀 /
- 梗死体积
Abstract: Objective: We examined the efficiency of statin on restricting infarction volume among acute ischemic stroke patients.Method: Patients with acute ischemic stroke symptom onset 24 hours or less were prospectively enrolled and randomized to atorvastatin (40 mg/d) or control group for 2 weeks. MRI were obtained at 1 week and 3 months after stroke onset. In addition, lipid level, inflammation markers and neurological function outcome were also evaluated.Result: Thirty-nine patients were taken MRI twice, 20 of whom received atorvastatin and of whom were in control group. There was significant difference between two groups on infarct volume change rate (P=0.002). Compared with patients from control group, atorvastatin patients tended to have increased frequency of infarction volume decrement at 3 months after onset (71.4% vs 27.8%, P=0.010). In multivariate logistic regression, no statin treatment in acute phase and high admission NIHSS were independent risk factors of increased infarct volume.Conclusion: These present preliminary results suggest that statin treatment in the acute phase of ischemic stroke may decrease infarction lesions. It can be a complementary observation indicator to evaluate the efficiency of drug intervention. However, more sophisticated experiments and large clinical trials are needed to confirm whether neuroprotective effects might be obtained by statins in the acute stage of ischemic stroke.
- acute ischemic stroke /
- statin /
- infarction volume

HTML全文

参考文献(29)

[1]	AMARENCO P,BOGOUSSLAVSKY J,CALLAHAN A,et al.High-dose atorvastatin after stroke or transient ischemic attack[J].N Engl J Med,2006,355:549-559.
[2]	GEWALTIG M T,KOJADA G.Vasoprotection by nitric oxide:mechanisms and therapeutic potential[J].Cardiovasc Res,2002,55:250-260.
[3]	ENDRES M,LAUFS U,HUANG A,et al.Stroke protection by 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase inhibitors mediated by endothelial nitric oxide synthase[J].Proc Natl Acad Sci USA,1998,95:8880-8885.
[4]	VAUGHAN C J,DELANTY N.Neuroprotective properties of statins in cerebral ischemia and stroke[J].Stroke,1999,30:1969-1973.
[5]	AMIN-HANJANI S,STAGLIANO N E,YAMADA M,et al.Mevastatin,an HMG-CoA reductase inhibitor,reduces stroke damage and upregulates endothelial nitric oxide synthase in mice[J].Stroke,2001,32:980-986.
[6]	GOLDSTEIN L B,AMARENCO P,ZIVIN J,et al.Statin treatment and stroke outcome in the stroke prevention by aggressive reduction in cholesterol levels (SPARCL) trial[J].Stroke,2009,40:3526-3531.
[7]	MARTI-FABREGAS J,GOMIS M,ARBOIX A,et al.Favorable outcome of ischemic stroke in patients pretreated with statins[J].Stroke,2004,35:1117-1121.
[8]	DEPLANQUE D,MASSE I,LEFEBVRE C,et al.Prior TIA,lipid-lowering drug use,and physical activity decrease ischemic stroke severity[J].Neurology,2006,67:1403-1410.
[9]	ALVAREZ-SABIN J,HUERTAS R,QUINTANA M,et al.Prior statin use may be associated with improved stroke outcome after tissue plasminogen activator[J].Stroke,2007,38:1076-1078.
[10]	BERGER C,XIA F,MAURER M H,et al.Neuroprotection by pravastatin in acute ischemic stroke in rats[J].Brain Res Rev,2008,58:48-56.
[11]	SHOOK S J,GUPTA R,VORA N A,et al.Statin use is independently associated with smaller infarct volume in nonlacunar MCA territory stroke[J].J Neuroimaging,2006,16:341-346.
[12]	ELKIND M S,FLINT A C,SCIACCA R R,et al.Lipid-lowering agent use at ischemic stroke onset is associated with decreased mortality[J].Neurology,2005,65:253-258.
[13]	MOONIS M,KANE K,SCHWIDERSKI U,et al.HMG-CoA reductase inhibitors improve acute ischemic stroke outcome[J].Stroke,2005,36:1298-1300.
[14]	ALLEN N B,BRASS L M,CERESE J,et al.Use of lipid-lowering agents during acute ischemic stroke decreases in-hospital mortality[J].Stroke,2006,37:625.
[15]	STEAD L G,VAIDYANATHAN L,KUMAR G,et al.Statins in ischemic stroke:just low-density lipoprotein lowering or more[J]?J Stroke Cerebrovasc Dis,2009,18:124-127.
[16]	MONTANER J,CHACÓN P,KRUPINSKI J,et al.Simvastatin in the acute phase of ischemic stroke:a safety and efficacy pilot trial[J].Eur J Neurol,2008,15:82-90.
[17]	BROTT T,ADAMS H P,OLINGER C P,et al.Measurements of acute cerebral infarction:a clinical examination scale[J].Stroke,1989,20:864-870.
[18]	中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[19]	ADAMS H P,BENDIXEN B H,KAPPELLE L J,et al.Classification of subtype of acute ischemic stroke[J].Stroke,1993,24:35-41.
[20]	VAN SWIETEN J C,KOUDSTAAL P J,VISSER M C,et al.Interobserver agreement for the assessment of handicap in stroke patients[J].Stroke,1988,19:604-607.
[21]	KOKOTAILO R A,HILL M D.Coding of stroke and stroke risk factors using international classification of diseases,revisions 9 and 10[J].Stroke,2005,36:1776-1781.
[22]	CHOBANIAN A V,BAKRIS G L,BLACK H R,et al.The seventh report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure:the JNC 7 report[J].JAMA,2003,289:2560-2572.
[23]	ALBERTI K G,ZIMMET P Z.Definition,diagnosis and classification of diabetes mellitus and its complications Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].DiabetesMed,1998,15:539-553.
[24]	Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults.Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection,evaluation,and treatment of high blood cholesterol in adults(adult treatment panel Ⅲ)[J].JAMA,2001,285:2486-2497.
[25]	ELKIND M S,FLINT A C,SCIACCA R R,et al.Lipid-lowering agent use at ischemic stroke onset is associated with decreased mortality[J].Neurology,2005,65:253-258.
[26]	AMARENCO P,LABREUCHE J.Lipid management in the prevention of stroke:review and updated meta-analysis of statins for stroke prevention[J].Lancet Neurol,2009,8:453-463.
[27]	BLANCO M,NOMBELA F,CASTELLANOS M,et al.Statin treatment withdrawal in ischemic stroke:a controlled randomized study[J].Neurology,2007,69:904-910.
[28]	FINK J N,SELIM M H,KUMAR S,et al.Is the association of National Institutes of Health Stroke Scale scores and acute magnetic resonance imaging stroke volume equal for patients with right-and left-hemisphere ischemic stroke[J]?Stroke,2002,33:954-948.
[29]	MILLIS S R,STRAUBE D,IRAMANEERAT C,et al.Measurement properties of the National Institutes of Health Stroke Scale for people with right-and left-hemisphere lesions:further analysis of the clomethiazole for acute stroke study-ischemic (class-I) trial[J].Arch Phys Med Rehabil,2007,88:302-308.