自发性脑出血患者的他汀应用和脑微出血情况分析

Statin use and cerebral microbleeds in patients with spontaneous intracerebral hemorrhage

目的探讨他汀的应用是否和不断增长的脑微出血相关,尤其与皮质、皮质下微出血(csMB)的相关性。方法回顾分析163例发病30 d内经过磁共振检查的脑出血的临床资料,将患者分为皮质、皮质下微出血(csMB)和其他位置的微出血(oMB),并对磁共振上微出血的位置和数量进行比较,根据是否应用他汀、是否存在微出血(MB)、是否有皮质、皮质下微出血(csMB)分别进行分组比较。结果 64%患者有脑叶出血,53%患者有微出血(MB),39%患者皮质、皮质下微出血(csMB)。他汀的应用导致胆固醇和低密度脂蛋白显著降低,其中应用他汀的患者患有高血压、糖尿病、血脂紊乱、抗血小板的几率较大,应用他汀治疗的和未应用的患者中其他位置的微出血(oMB)数量相似,他汀治疗患者中存在更多的csMB(57%vs.33%,P=0.007),几乎是未应用他汀患者的2倍(4.6±2.7 vs.2.4±1.8,P<0.001)。多变量因素分析表明,年龄和他汀的应用是MB(OR=1.03;95%CI∶1.00~1.05;P=0.01和OR=2.72;95%CI∶1.02~7.22;P=0.04)和csMB(OR=1.03;95%CI∶1.00~1.06;P=0.01和OR=4.15;95%CI∶1.54~11.20,P<0.01)的独立危险因素。结论脑出血患者中他汀的应用与MB尤其是csMB相关,但需要更多的研究去确认csMB是否可以作为他汀应用患者脑出血的风险标志。

Objective To explore the association between with increased risk of intracerebral hemorrhage(ICH),particularly in elderly patients with previous ICH.So we investigated whether statin use is associated with increased prevalence of microbleeding(MB),particularly cortico-subcortical microbleeding(csMB).Methods The data of 163 cerebral hemorrhage patients with MRI examination within 30 d of onset.The patients were divided into cortical,subcortical microbleeding(csMB)and microbleeding(oMB)locations,and the location and number of microbleed were compared,and patients were divided into groups according to whether statins were used,whether there was microbleeds(MB),cortical or subcortical microbleeding(csMB).Results There were 64%patients with lobar ICH,53%with microbleed and 39%with csMB.The application of statin had lower cholesterol and low-density lipoprotein levels,and patients with statin had higher incidence rate of hypertension,diabetes,dyslipidemia,and antiplatelet disease.The number of oMB in patients with statin and without statin were similar,and statin-treated patients had more csMB(57%vs.33%,P=0.007),with almost twice of patients without statin treatment(4.6±2.7 vs.2.4±1.8;P<0.001).Multivariate factor analysis showed that age and statin use were independently risk factors for MB(OR=1.03;95%CI∶1.00~1.05;P=0.01,OR=2.72;95%CI∶1.02~7.22;P=0.04,respectively)and csMB(OR=1.03;95%CI∶1.00~1.06;P=0.01 and OR=4.15;95%CI∶1.54~11.20,P<0.01).Conclusion Statin use in patients with ICH is independently associated with MB,especially csMB.Future studies are needed to confirm our findings and to investigate whether csMB can serve as a marker for ICH risk in statin-treated patients.