Preexisting statin use is associated with greater reperfusion in hyperacute ischemic stroke.
Preexisting statin use is associated with greater reperfusion in hyperacute ischemic stroke.
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DOI：
10.1161/strokeaha.110.600957
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发表时间：
2011-05
期刊：
影响因子：
8.3
通讯作者：
Lee JM
中科院分区：
文献类型：
--
作者：
Ford AL;An H;D'Angelo G;Ponisio R;Bushard P;Vo KD;Powers WJ;Lin W;Lee JM
他汀类药物预处理与改善缺血性中风患者的预后有关。尽管已经在动物模型中研究了几种机制，但在患者中研究的很少。我们假设在卒中发作前使用他汀类药物的患者可能比不使用他汀类药物的患者有更大的再灌注。急性缺血性中风患者接受两次 MR 扫描：中风发作后 4.5 小时内 (tp1) 和 6 小时内 (tp2)。再灌注区域由 tp1 处延长的 MTT 定义，并在 tp2 处正常化。评估了四个 MTT 阈值，以确保结果不是虚假地基于任意阈值。比较了卒中发作时服用他汀类药物的患者和未服用他汀类药物的患者的基线特征、相对再灌注以及 tp1 和 1 个月随访期间 NIH 卒中量表的变化 (ΔNIHSS)。前瞻性招募了 31 名中风患者； 12 人服用他汀类药物，19 人未服用他汀类药物。两组之间的基线特征没有差异，只是他汀类药物组的冠状动脉疾病更严重（p=0.03）。与未治疗的患者相比，使用他汀类药物的患者在所有 MTT 阈值上均表现出明显更高的再灌注。对于 MTT=4 秒，已有他汀类药物组的中位相对再灌注率为 50%（IQR 30%,56%），而未治疗组为 13%（IQR=5%,36%），p=0.014。与未治疗组（4.4±5.7分）相比，他汀类药物组的ΔNIHSS（8.8±4.0分）更大，p=0.028。缺血性中风发作前使用他汀类药物与早期再灌注和 NIHSS 改善有关。需要对更多人群进行进一步研究来证实我们的初步发现。
Statin pretreatment has been associated with improved outcomes in patients with ischemic stroke. Although several mechanisms have been examined in animal models, few have been examined in patients. We hypothesized that patients using statins before stroke onset may have greater reperfusion than patients not using statins. Acute ischemic stroke patients underwent two MR scans: within 4.5 (tp1) and at 6 hours (tp2) after stroke onset. Regions of reperfusion were defined by prolonged MTT at tp1 which normalized at tp2. Four MTT thresholds were assessed to ensure that results were not spuriously based on an arbitrary threshold. Baseline characteristics, relative reperfusion, and change in NIH Stroke Scale between tp1 and 1-month follow-up (ΔNIHSS) were compared between patients who were taking statins at stroke onset and those who were not. Thirty-one stroke patients were prospectively enrolled; 12 were taking statins, while 19 were not. Baseline characteristics did not differ between the two groups except the statin group had greater coronary artery disease (p=0.03). Patients using statins showed significantly greater reperfusion compared to untreated patients across all MTT thresholds. For MTT=4 seconds, median relative reperfusion was 50% (IQR 30%,56%) in the pre-existing statin group vs. 13% (IQR=5%,36%) in the untreated group, p=0.014. The statin group had greater ΔNIHSS (8.8±4.0 points) compared to the untreated group (4.4±5.7 points), p=0.028. Statin use prior to ischemic stroke onset was associated with greater early reperfusion and NIHSS improvement. Further studies in larger populations are required to confirm our preliminary findings.