Statin use was not associated with less vasospasm or improved outcome after subarachnoid hemorrhage
Statin use was not associated with less vasospasm or improved outcome after subarachnoid hemorrhage
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DOI：
10.1227/01.neu.0000316009.19012.e3
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发表时间：
2008-02-01
期刊：
影响因子：
4.8
通讯作者：
Bleck, Thomas P.
中科院分区：
文献类型：
--
作者：
Kramer, Andreas H.;Gurka, Matthew J.;Bleck, Thomas P.
目的：脑血管痉挛引起的迟发性缺血的发展仍然是蛛网膜下腔出血后发病和死亡的常见原因。初步研究表明，3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）可能会降低血管痉挛的风险，但额外的研究是required. METHODS：在2006年5月开始，我们的治疗方案与蛛网膜下腔出血的患者进行了改变，包括常规使用辛伐他汀80毫克，每天14天。在此之前，只有其他适应症的患者接受他汀类药物治疗。回顾性分析了203例连续患者在27个月内的图表，150例患者纳入分析，其中71例患者接受他汀类药物治疗。将这些患者与79名未治疗患者进行比较，以确定他汀类药物的使用是否与血管痉挛、迟发性梗死或不良结局的发生率降低相关（死亡、植物人状态或严重残疾）。接受他汀类药物治疗的患者和未接受他汀类药物治疗的患者具有相似的基线特征，尽管前一组中更多的患者采用血管内弹簧圈栓塞治疗。发生至少中度放射学血管痉挛的患者比例无统计学显著差异（41%使用他汀类药物vs 42%未使用，P = 0.91），症状性血管痉挛（32%使用他汀类药物vs 25%未使用，P = 0.34），迟发性梗死（23%使用他汀类药物，28%未使用，P = 0.46）或不良结局（39%使用他汀类药物，35%未使用，P = 0.61）。调整后的基线特征的差异，包括动脉瘤治疗的方法，他汀类药物仍然没有显着protective. CONCLUSION：除了他汀类药物的标准治疗与任何减少血管痉挛的发展或改善后蛛网膜下腔出血的结局。如果使用他汀类药物有好处，它可能比以前的研究所建议的要小。然而，还有待进一步的随机对照试验。
OBJECTIVE: The development of delayed ischemia caused by cerebral vasospasm remains a common cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage. Preliminary studies suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may decrease the risk of vasospasm, but additional study is required.METHODS: Beginning in May 2006, our treatment protocol for patients presenting with subarachnoid hemorrhage was altered to routinely include the use of 80 mg of simvastatin per day for 14 days. Before this time, only patients with other indications for statins were treated. The charts of 203 consecutive patients over a period of 27 months were retrospectively reviewed, and 150 patients were included in the analysis, of whom 71 patients received statins. These patients were compared with 79 untreated patients to determine whether or not the use of statins was associated with a reduction in the occurrence of vasospasm, delayed infarction, or poor outcome (death, vegetative state, or severe disability).RESULTS: Patients who were treated with statins and those who were not had similar baseline characteristics, although more patients in the former group were managed with endovascular coil embolization. There were no statistically significant differences in the proportion of patients developing at least moderate radiographic vasospasm (41% with statins versus 42% without, P = 0.91), symptomatic vasospasm (32% with statins versus 25% without, P = 0.34), delayed infarction (23% with statins versus 28% without, P = 0.46), or poor outcome (39% with statins versus 35% without, P = 0.61). After adjustment for differences in baseline characteristics, including the method of aneurysm treatment, statins were still not significantly protective.CONCLUSION: The addition of statins to standard care was not associated with any reduction in the development of vasospasm or improvement in outcomes after aneurysmal subarachnoid hemorrhage. If there is a benefit to statin use, it may be smaller than suggested by previous studies. However, further randomized controlled trials are awaited.