Prior statin use may be associated with improved stroke outcome after tissue plasminogen activator
Prior statin use may be associated with improved stroke outcome after tissue plasminogen activator
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DOI：
10.1161/01.str.0000258075.58283.8f
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发表时间：
2007-03-01
期刊：
影响因子：
8.3
通讯作者：
Montaner, Joan
中科院分区：
文献类型：
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作者：
Alvarez-Sabin, Jose;Huertas, Rafael;Montaner, Joan
背景和目的-他汀类药物可能发挥一定的神经保护作用，因为在中风发作前使用他汀类药物与更好的预后和降低死亡率有关。本研究的目的是评估中风前服用他汀类药物后，接受组织纤溶酶原激活剂治疗的患者是否有更好的预后。方法：我们评估了145例涉及大脑中动脉的中风患者（接受组织纤溶酶原激活剂治疗< 3小时）。结果：58例患者（40%）在3个月时功能独立。与良好结果相关的因素是年龄（68岁对74.4岁，P < 0.001）、基线美国国立卫生研究院卒中量表评分（13分对18分，P < 0.001）和大脑中动脉近端闭塞（56.1%对84.3%,P < 0.001）。他汀类药物是中风前服用的唯一影响神经系统预后的药物。事实上，在功能独立的患者中，27.3%的患者在指数卒中时使用他汀类药物，而在研究期结束时依赖或死亡的患者组中，这一比例为13.6% （P=0.046）。logistic回归模型确定基线美国国立卫生研究院卒中量表评分< 15 （OR: 5.8, 95% CI: 2.05 ~ 16.36, P = 0.001）、年龄< 70岁（OR: 2.93, 95% CI: 1.13 ~ 7.59, P = 0.027）和既往他汀类药物治疗（OR: 5.26, 95% CI: 1.48 ~ 18.72, P = 0.027）为良好功能结局的独立预测因子。结论：中风时接受他汀类药物治疗的患者接受溶栓治疗后神经系统预后得到改善。
Background and Purpose - Statins may exert some neuroprotection, because use before stroke onset has been related to better outcome and reduced mortality. The purpose of this study was to evaluate whether patients who receive tissue plasminogen activator have better outcome when statins were taken before stroke.Methods - We evaluated 145 patients with a stroke involving the middle cerebral artery (who received tissue plasminogen activator treatment (< 3 hours).Results - Fifty-eight patients (40%) became functionally independent at 3 months. Factors associated with good outcome were age ( 68 versus 74.4 years, P < 0.001),baseline National Institutes of Health Stroke Scale score ( 13 versus 18, P < 0.001),and proximal middle cerebral artery occlusion (56.1% versus 84.3%, P < 0.001). Statins were the only drug taken before stroke that conditioned neurologic outcome. In fact, among patients who were functionally independent, 27.3% were under statins at the time of the index stroke as compared with 13.6% among the group of patients who were dependent or dead by the end of the study period (P=0.046). A logistic regression model identified baseline National Institutes of Health Stroke Scale score < 15 ( OR: 5.8, 95% CI: 2.05 to 16.36, P = 0.001), age < 70 years ( OR: 2.93, 95% CI: 1.13 to 7.59, P = 0.027), and previous treatment with statins (OR: 5.26, 95% CI: 1.48 to 18.72, P = 0.027) as independent predictors of good functional outcome.Conclusions - Patients under statins at the moment of stroke who received thrombolytics had an improved neurologic outcome.