Statin treatment may lower the risk of postradiation epilepsy in patients with nasopharyngeal carcinoma
Statin treatment may lower the risk of postradiation epilepsy in patients with nasopharyngeal carcinoma
复制标题
他汀类药物治疗可降低鼻咽癌患者放射后癫痫的风险
DOI：
10.1111/epi.13924
复制
发表时间：
2017-12-01
期刊：
影响因子：
5.6
通讯作者：
Peng, Ying
中科院分区：
文献类型：
--
作者：
Rong, Xiaoming;Yin, Jing;Peng, Ying
目的：探讨他汀类药物预防放疗后癫痫的作用。方法：对有放射治疗病史的神经科鼻咽癌患者进行回顾性分析。放射前有癫痫病史和接受预防性抗癫痫治疗的患者被排除在外。通过图表回顾收集这些患者的人口学和临床资料。我们使用Kaplan-Meier分析(对数列检验)来检验他汀类药物对无癫痫生存的影响。结果：本研究共纳入532例患者(男405例，女127例)，平均随访28.1个月。在随访期间，471例(88.5%)患者发生了放射性脑坏死(RN)。在平均24.1个月的潜伏期内，88例(16.5%)患者有癫痫发作，其中27例(27/88，30.7%)在RN诊断前已有癫痫发作。发作后癫痫36例(40.9%)，以RN为首发症状的22例(25.0%)。有3例患者患有癫痫，但没有RN。88例患者因高脂血症或预防心脑血管疾病而接受他汀类药物治疗，其中6例(6.8%)发生癫痫，而未服用他汀类药物的患者癫痫发生率为18.5%。LOG-RANK检验发现，使用他汀类药物的患者和不使用他汀类药物的患者之间的无癫痫生存率有显著差异(p=0.016)。在调整混杂变量后，多因素COX回归分析显示，他汀类药物仍可显著降低放射后癫痫的风险(危险比=0.36，95%可信区间=0.15-0.82，p=0.015)。然而，对于已经患有RN的患者，他汀类药物治疗并没有降低RN后癫痫的风险。意义：早期使用他汀类药物可能会降低鼻咽癌患者放射治疗后癫痫的风险。
Objective: This study aimed to clarify the effect of statins on preventing the risk of postradiation epilepsy.Methods: We performed a retrospective analysis of neurological nasopharyngeal carcinoma patients with a history of radiotherapy. Patients with a history of epilepsy before radiation and those who received prophylactically antiepileptic treatment were excluded. The demographic and clinical data of these patients were collected through chart review. We used Kaplan-Meier analysis (log-rank test) to examine the effect of statins on epilepsy-free survival. Cox regression analysis was utilized to identify independent predictive variables.Results: Our study included 532 patients (405 males and 127 females) with a mean follow-up of 28.1 months. During follow-up, 471 (88.5%) patients developed radiation-induced brain necrosis (RN). Within a mean latency of 24.1 months, 88 (16.5%) patients experienced epilepsy, of whom 27 (27 of 88, 30.7%) patients suffered from epilepsy before the diagnosis of RN. Thirty-six (36 of 88, 40.9%) cases of epilepsy occurred after RN onset, and in 22 cases (22 of 88, 25.0%) epilepsy was the first presentation of RN. Three patients suffered from epilepsy but did not have RN. Eighty-eight patients in our cohort were treated with statins because of hyperlipidemia or prevention of cardiocerebrovascular diseases, of whom six (6.8%) developed epilepsy, whereas in those without statin, the epileptic rate was 18.5%. Log-rank test found that there was a significant difference in epilepsy-free survival between patients who used statins and those who did not (p = 0.016). After adjusting for confounding variables, multivariate Cox regression analysis revealed that statin use could still significantly reduce the risk of epilepsy after radiation (hazard ratio = 0.36, 95% confidence interval = 0.15-0.82, p = 0.015). However, for the patients who already suffered from RN, statin treatment did not lower the risk of post-RN epilepsy.Significance: Early statin use may reduce the risk of postradiotherapy epilepsy in patients with nasopharyngeal carcinoma.