他汀对缺血性脑卒中急性期和远期作用的研究

Acute and long-term effect of statin on ischemic stroke

目的探讨卒中前应用他汀类药物是否可以改善缺血性脑卒中严重程度和急性期预后,以及卒中后应用他汀类药物对神经功能恢复和远期预后的影响。方法回顾性分析缺血性脑卒中患者654例。根据是否应用他汀类药物分为他汀组和非他汀组。临床特征从病历获得,卒中严重程度应用美国国立卫生研究院卒中量表(NIHSS)评估。随访以门诊随访为主,辅以电话随访、住院随访等,应用改良Rankin量表(MRS)评估神经功能状态。生存率估算应用Kaplan-Meier法,组间生存率曲线差异采用log-rank检验。结果卒中前有104例患者应用他汀类药物(他汀组),550例未应用他汀类药物(非他汀组)。2组之间NIHSS评分差异无统计学意义(Z=0.412,P=0.484),急性期生存曲线差异无统计学意义(χ2=0.201,P=0.654)。卒中后纳入分析的523例患者中有312例接受他汀类药物治疗(他汀组),211例未接受他汀药物治疗(非他汀组)。随访1年时他汀组神经功能显著优于非他汀组(χ2=8.599,P=0.003),并且2组的生存曲线差异存在统计学意义(χ2=5.147,P=0.023)。结论卒中前应用他汀类药物并未明显改善缺血性脑卒中的严重程度和急性期预后,但是卒中后应用他汀类药物可以改善患者的长期预后和神经功能,这对于缺血性脑卒中的治疗和康复具有重要的指导意义。

Objective To examine whether prestroke use of statins can improve initial stroke severity and short-term sur- vival and to assess the effect of poststroke treatment with statins on neurological function and long-term survival. Methods 654 cases of patients with ischemic stroke were retrospective analyzed. The subjects were divided into statin group and non-statin group depending on the application of statin. Clinical characteristics were acquired from medical re- cord and stroke severity was assessed with the application of National Institutes of Health Stroke Scale（NIHSS）. The main form of follow-up was out-patient follow-up, supplemented by patient follow-up and telephone follow-up. Modified Rankin Scale（MRS） was applied to assess the neurological status. Kaplan-Meier method was used to estimate survival rate. The survival difference between the two groups was compared using the log-rank test. Results 104 patients received statins （statin group） and 550 cases didn＇t（ non-statin group） before stroke. NIHSS score was no significant difference between the 2 groups（Z = 0. 412,P = 0.484）. No significant difference was found in the acute survival curves （X^2 = 0. 201, P = 0. 654）. In 523 analyzed patients after stroke, 312 patients received statin therapy （statin group ） , 211 cases did not re- ceive statins（ non-statin group）. The neurologie functional outcome at 1 year after stroke was better in statin group com- pared with non-statin group （ X^2 = 8. 599, P = 0. 003 ）. The survival curves of the two groups were significantly different （ X^2 = 5. 147, P = 0.023 ）. Conclusion The application of statins before stroke did not significantly improve the severity and acute prognosis in ischemic stroke patients. But statins treatment after stroke can improve the patient＇ s long-term prognosis and neurologic function, which had important guiding significance for ischemie stroke treatment and rehabilita- tion.