急性缺血性脑卒中他汀类药物剂量和疗程与软脑膜侧支的相关性研究

Correlation of statin dose and duration with leptomeningeal collaterals in acute ischemic stroke

目的确定他汀类药物治疗(包括剂量和治疗时间)对大脑中动脉闭塞(MCAO)患者软脑膜侧支(LMC)建立的影响。方法回顾性选取2014年1月至2020年12月在首都医科大学附属北京友谊医院住院的大脑中动脉近端(M1或M2段)闭塞患者,收集187例患者的人口学数据、临床和影像学资料。根据头颈CT血管造影(CTA)结果将LMC分为5级,1级和2级为代偿良好组,3-5级为代偿不良组。根据LMC的分级,将患者分为LMC良好组(113例,60.43%)和LMC不良组(74例,39.57%)。应用Logistic回归分析明确影响LMC的独立预测因素。结果LMC不良组的患者具有较高的血清总胆红素水平(P=0.006)、血清直接胆红素水平(P=0.010)和血清间接胆红素水平(P=0.020)。LMC良好组患者具有较少的下肢动脉狭窄或闭塞(P=0.060)和更多的他汀类药物治疗(P=0.087)。他汀类药物治疗与良好的LMC独立相关(OR=3.21,95%CI:1.05-9.85;P=0.041)。下肢动脉狭窄或闭塞与不良的LMC独立相关(OR=0.08,95%CI:0.08-0.24,P=0.035)。在使用他汀类药物的患者中,相关分析显示他汀类药物剂量与LMC分级呈正相关(r=0.428,P=0.037)。但他汀类药物治疗时间与LMC分级无关(r=-0.243,P=0.253)。结论他汀类药物治疗是良好LMC的独立预测因子。在5-40 mg/d的阿托伐他汀当量剂量范围内,剂量越大,LMC代偿越好。

Objective To identify the effect of statin treatment,including dosage and treatment duration,on leptomeningeal collaterals(LMC)establishment in patients with middle cerebral artery(MCA)occlusion.Methods The patients with proximal(M1 or M2 segment)occlusion of 187 MCA who were admitted to Beijing Friendship Hospital affiliated to Capital Medical University from January 2014 to December 2019 were included,demographic,clinical and imaging data were collected.According to CTA results,LMCs were classified into 5 grades.Grades 1 and 2 were considered as good and grades 3-5 as poor.According to the classification of LMC,the patients were divided into LMC good group(113 cases,60.43%)and LMC poor group(74 cases,39.57%).Logistic regression analysis was used to identify the independent predictors of LMC.Results Patients in the poor LMC group had higher serum total bilirubin levels(P=0.006),serum direct bilirubin levels(P=0.010),and serum indirect bilirubin levels(P=0.020).Patients in the good LMC group had less lower extremity arterial stenosis or occlusion(P=0.060)and more statin therapy(P=0.087).Statin treatment(OR=3.21,95%CI:1.05-9.85,P=0.041)was independently associated with good LMC,and arterial stenosis or occlusion in the lower limb(OR=0.08,95%CI:0.08-0.24,P=0.035)was independently associated with poor LMC.In the statin users,correlation analysis showed a positive association between statin dosage and LMC grade(r=0.428,P=0.037).However,the duration of statin treatment was not found to be associated with LMC grade(r=-0.243,P=0.253).Conclusion Statin treatment was an independent predictor of good LMC.In the range of 5-40 mg/d of atorvastatin-equivalent dose,a higher dosage predicts a better LMC.