发病前应用阿托伐他汀钙治疗对初发脑梗死患者近期预后的影响

The impact of atorvastatin pretreatment on recent outcome of first-ever ischemic stroke

目的通过观察发病前开始阿托伐他汀钙治疗对初发脑梗死患者近期预后的影响，分析他汀类药物在脑梗死急性期的脑保护作用。方法纳入2011-2013年期间在本科连续住院120例初发脑梗死患者，发病前开始治疗组为发病前已开始服用阿托伐他汀钙的患者45例。发病后治疗组为发病24h后开始阿托伐他汀钙治疗的患者75例。登记患者高血压、糖尿病、冠心病及高脂血症史，依据影像学资料行卒中分型（采用TOAST分型）行颈动脉彩超检查并计算患者平均颈动脉内-中膜厚度（IMT），在入院时及发病3个月时行美国国立卫生院神经功能缺损评分（ NIHSS）和改良Rankin评分（ mRS评分）。以脑卒中发病后3个月时mRS≤2定义为预后良好，mRS≥3为预后较差的标准。入院时及发病3个月时行血脂分析检查。对两组患者之间的基线资料、平均颈动脉IMT、入院NIHSS、预后及TOAST分型进行对照分析，不同预后的患者进行二元Logistic回归分析发病预测因素。结果发病前开始治疗组良好预后的数量、患有高脂血症患者数量较发病后治疗组明显更多，且发病前开始治疗组有明显更低的NIHSS评分（ P＜0．05）。 Logistic回归分析提示冠状动脉性心脏病（ OR 0．13，95％CI 0．03～0．39，P＝0．006）、发病前开始阿托伐他汀钙治疗（ OR 4．8，95％CI 1．23～19．00，P＝0．025）、入院时NIHSS（ OR 1．15，95％CI 1．01～1．26，P＝0．012）是卒中后近期预后的独立预测因素。结论发病前开始服用阿托伐他汀钙可能有助于改善脑梗死患者近期预后，这种作用可能源自他汀类药物的神经保护作用。

Objective To prospect investigate the impact of atorvastatin pretreatment on 3 months outcome of first-ever ischemic stroke .Methods 120 first-ever ischemic stroke cases who invited our department of neurology during 2011-2013 were enrolled , including 45 patients who were receiving atorvastatin treatment before onset of stroke （statins-pretreated group ） and 75 patients who were not （ without statins-pretreated group ）.Risk factors （ hypertension , diabetes mellitus , coronary heart disease , hyperlipidemia ） for stroke of all patients were registered . The mean intima-media thickness （ m-IMT ） of carotid artery of each patient were measured respectively by color Doppler ultrasound .The neurologic functions and disabilities were evaluated by using NIHSS and mRS assessing system.Good outcome was defined as mRS≤2 at 3 months after stroke and bad outcome was defined as mRS≥3 at the same time.Regarding the image result , the TOAST stroke subclassification of every patient was determined .Lipid profile was measured at onset and 3 months after stroke.Baseline characteristics, m-IMT, NIHSS on admission, TOAST stroke subclassification and prognosis were compared between the two groups .The multivariate analysis about the predictive factors for outcome was completed with Logistic regression procedure .Results Comparing with the group without statins-pretreated , outcome was better and NIHSS scores at onset of stroke were lower in the statins -pretreated group, significantly（P〈0.05）.Result of the Logistic regression analysis indicated that NIHSS on admission （OR 1.15,95%CI 1.01-1.26,P=0.012）, statins pretreatment（OR 4.8,95%CI 1.23-19.00,P=0.025）,coronary heart disease（OR 0.13,95%CI 0.03-0.39,P=0.006）were associated with outcome of stroke.Conclusion Using of atorvastatin before ischemic stroke is associated with favorable recent outcome with reduced recent neurological disability, and neuroprotection may be the potential mechanism .