Effects of atorvastatin on chronic subdural hematoma: A preliminary report from three medical centers
Effects of atorvastatin on chronic subdural hematoma: A preliminary report from three medical centers
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阿托伐他汀对慢性硬膜下血肿的影响：来自三个医疗中心的初步报告
DOI：
10.1016/j.jns.2013.11.005
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发表时间：
2014-01-15
影响因子：
4.4
通讯作者：
Zhang, Jianning
中科院分区：
文献类型：
--
作者：
Wang, Dong;Li, Tuo;Zhang, Jianning
引言：慢性硬膜下血肿（CSDH）在老年人群中较为常见。手术是治疗的首选，但其结果可能并不令人满意，因为复发和身体虚弱与老化。异常的血管生成和局部炎症有助于CSDH的形成。阿托伐他汀具有促进血管生成和调节炎症的活性。我们假设，阿托伐他汀是有效的，减少CSDH，并在一个初步的前瞻性研究的小队列patients.Methods：23例CT或MRI证实的CSDH从三个区域的医疗中心和Markwalder的分级量表（MGS）和格拉斯哥昏迷量表（GCS）进行了评估。这些患者接受口服阿托伐他汀20 mg/天治疗1-6个月（3.02 +/- 1.77个月），并在治疗后随访3 - 36个月（18.62 +/- 13.13）。血肿体积、神经功能和日常活动采用Barthel指数量表（ADL-BI）对两组患者治疗前后的日常生活活动能力（ADL）进行比较，采用线性趋势卡方检验。23名患者中有22名症状有所改善，在治疗的第一个月内，血肿体积从48.70 +/- 20.38 ml减少到16.64 +/- 14.28 ml（配对样本t检验，p < 0.01）。治疗开始后3个月，17例患者（77.3%）的血肿完全消退，5例患者（22.7%）的血肿缩小超过73.99% ± 11.17%。1例患者的症状初步缓解，但在治疗的第4周，他的病情恶化，血肿扩大，并接受了手术。6个月时，18例患者CT或MRI显示无血肿，4例患者血肿在3个月时完全消退，未进行随访。在3-36个月的整个随访期内，这22例患者均未复发。所有患者的MGS、GCS和ADL-BI均有所改善。没有阿托伐他汀相关的副作用被documented.Conclusion：这个初步的前瞻性研究的结果表明，口服阿托伐他汀是安全和有效的治疗CSDH，提供了一个具有成本效益的替代手术。需要进行前瞻性随机临床试验来验证阿托他汀的效果。(C)2013爱思唯尔有限公司版权所有。
Introduction: Chronic subdural hematoma (CSDH) is common and more prevalent in the aged population. Surgical intervention is the treatment of choice, but its outcomes may not be satisfactory because of recurrence and physical infirmity associated with aging. Aberrant angiogenesis and localized inflammation contribute to the formation of CSDH. Atorvastatin is active in promoting angiogenesis and modulating inflammation. We hypothesize that atorvastatin is effective in reducing CSDH and have tested the hypothesis in a preliminary prospective study of small cohort of patients.Methods: Twenty-three patients with CT- or MRI-confirmed CSDH were recruited from three regional medical centers and evaluated using Markwalder's Grading Scale (MGS) and the Glasgow Coma Scale (GCS). These patients received oral atorvastatin 20 mg/day for 1-6 months (3.02 +/- 1.77 months) and were followed for 3 to 36 months (18.62 +/- 13.13) after the therapy. Hematoma volume, neurological functions and daily activities (measured using the Activities of Daily Life-the Barthel Index scale, ADL-BI) were compared before and after treatment with Linear Trend Chi-Square test.Results: Twenty-two of the 23 patients experienced improvements in symptoms, and the reduction in hematoma volume from 48.70 +/- 20.38 ml to 16.64 +/- 14.28 ml (paired-sample t-test, p < 0.01) within the first month of the treatment. Hematoma was completely resolved in 17 patients (77.3%) and shrank by more than 73.99% +/- 11.17% in 5 patients (22.7%) 3 months after the treatment was initiated. One patient experienced an initial relief of symptoms, but his condition deteriorated with an enlarged hematoma during the 4th week of treatment and underwent surgery. At 6 months, 18 patients presented no hematoma by CT or MRI and four patients, whose hematoma was completely resolved at 3 months, were not followed. None of these 22 patients relapsed during the entire follow-up period of 3-36 months. All have improved MGS, GCS, and ADL-BI. No atorvastatin-related side effects were documented.Conclusion: Results of this preliminary prospective study show that the oral administration of atorvastatin is safe and effective in treating CSDH, offering a cost-effective alternative to surgery. A prospective randomized clinical trial is required to validate the effect of atonrastatin. (C) 2013 Elsevier B.V. All rights reserved.