他汀类药物治疗与脑出血患者预后的研究进展
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摘要
脑卒中是成人死亡和残疾的最常见病因,其中脑出血是预后最差的卒中亚型。他汀类药物被常用于脑卒中的治疗,但其在脑出血患者中的获益和风险尚有争议,既往研究认为他汀类药物治疗会增加脑出血再发风险,但近期的大量研究提示脑出血患者予以他汀类药物不会增加脑出血发生率,且可通过多重药理作用,改善患者预后。该文将相关研究综述如下。
Stroke is the most common cause of death and disability in adults. Cerebral hemorrhage is the worst prognosis of stroke. Statins are commonly used in the treatment of stroke, but their benefits and risks in patients with cerebral hemorrhage are still controversial. Previous studies have suggested that statin therapy will increase the risk of recurrent cerebral hemorrhage, but a large number of recent studies suggest cerebral hemorrhage patients receiving statins do not increase the incidence of cerebral hemorrhage, and can improve the prognosis of patients through multiple pharmacological effects. This article summarizes the relevant research as follows.
Stroke is the most common cause of death and disability in adults. Cerebral hemorrhage is the worst prognosis of stroke. Statins are commonly used in the treatment of stroke, but their benefits and risks in patients with cerebral hemorrhage are still controversial. Previous studies have suggested that statin therapy will increase the risk of recurrent cerebral hemorrhage, but a large number of recent studies suggest cerebral hemorrhage patients receiving statins do not increase the incidence of cerebral hemorrhage, and can improve the prognosis of patients through multiple pharmacological effects. This article summarizes the relevant research as follows.
引文
[1] Siddiqui FM,Langefeld CD,Moomaw CJ,et al. Use of Statins and Outcomes in Intracerebral Hemorrhage Patients[J]. Stroke,2017,48(8):2098-2104.
[2] Gioia LC,Kate M,McCourt R,et al. Perihematoma cerebral blood flow is unaffected by statin use in acute intracerebral hemorrhage patients[J]. J Cereb Blood Flow Metab,2015,35(7):1175-1180.
[3] Ma Y,Li Z,Chen L. Blood lipid levels, statin therapy and the risk of intracerebral hemorrhage[J]. Lipids Heal. Dis,2016,15(1):1-9.
[4] Chen Z, Qureshi AR, Parini P,et al. Does statins promote vascular calcification in chronic kidney disease[J]. Eur J Clin Invest,2017,47(2):137-148.
[5] Pandit AK,Kumar P,Kumar A,et al. High-dose statin therapy and risk of intracerebral hemorrhage:a metaanalysis[J]. Acta Neurol Scand,2016,134(1):22-28.
[6] Pezzini A,Grassi M,Iacoviello L,et al. Serum cholesterol levels,HMG-CoA reductase inhibitors and the risk of intracerebral haemorrhage. The Multicenter Study on Cerebral Haemorrhage in Italy(MUCH-Italy)[J]. J Neurol Neurosurg Psychiatry,2016,87(9):924-929.
[7] Amarenco P,Bogousslavsky J,Callahan 3rd A,et al. Highdose atorvastatin after stroke or transient ischemic attack[J]. N Engl J Med,2006,355(6):549-559.
[8] Goldstein LB,Amarenco P,Szarek M,et al. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study[J]. Neurology,2008,70(24):2364-2370.
[9] Chen Q,Shi X,Tan Q,et al. Simvastatin Promotes Hematoma Absorption and Reduces Hydrocephalus Following Intraventricular Hemorrhage in Part by Upregulating CD36[J].Transl Stroke Res,2017,8(4):362-373.
[10] Flores JJ,Klebe D,Rolland WB,et al. PPARgammainduced up regulation of CD36 enhances hematoma resolution and attenuates long-term neurological deficits after germinal matrix hemorrhage in neonatal rats[J]. Neurobiol Dis,2016,87:124-133.
[11] Gaist D,Goldstein LB,Cea Soriano L,et al. Statins and the Risk of Intracerebral Hemorrhage in Patients With Previous Ischemic Stroke or Transient Ischemic Attack[J]. Stroke,2017,48(12):3245-3251.
[12] Ferretti G,Bacchetti T,Banach M,et al. Impact of Statin Therapy on Plasma MMP-3, MMP-9, and TIMP-1Concentrations:A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials[J]. Angiology,2017,68(10):850-862.
[13] Jung JM,Choi JY,Kim HJ,et al. Statin use in spontaneous intracerebral hemorrhage:a systematic review and metaanalysis[J]. Int J Stroke,2015,10(suppl A100):10-17.
[14] Tapia-Perez JH,Yildiz OC,Schneider T,et al. Metaanalysis of Statin Use for the Acute Therapy of Spontaneous Intracerebral Hemorrhage[J]. J Stroke Cerebrovasc Dis,2015,24(11):2521-2526.
[15] Chen PS,Cheng CL,Chang YC,et al. Early statin therapy in patients with acute intracerebral hemorrhage without prior statin use[J]. Eur J Neurol,2015,22(5):773-780.
[16] Heart Protection Study. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions[J]. Lancet,2004,363(9411):757-767.
[17] Schmidt LB, Goertz S, Wohlfahrt J,et al.Recurrent intracerebral hemorrhage:associations with comorbidities and medicine with antithrombotic effects[J]. PLoS One, 2016, 11(11):e0166223.
[2] Gioia LC,Kate M,McCourt R,et al. Perihematoma cerebral blood flow is unaffected by statin use in acute intracerebral hemorrhage patients[J]. J Cereb Blood Flow Metab,2015,35(7):1175-1180.
[3] Ma Y,Li Z,Chen L. Blood lipid levels, statin therapy and the risk of intracerebral hemorrhage[J]. Lipids Heal. Dis,2016,15(1):1-9.
[4] Chen Z, Qureshi AR, Parini P,et al. Does statins promote vascular calcification in chronic kidney disease[J]. Eur J Clin Invest,2017,47(2):137-148.
[5] Pandit AK,Kumar P,Kumar A,et al. High-dose statin therapy and risk of intracerebral hemorrhage:a metaanalysis[J]. Acta Neurol Scand,2016,134(1):22-28.
[6] Pezzini A,Grassi M,Iacoviello L,et al. Serum cholesterol levels,HMG-CoA reductase inhibitors and the risk of intracerebral haemorrhage. The Multicenter Study on Cerebral Haemorrhage in Italy(MUCH-Italy)[J]. J Neurol Neurosurg Psychiatry,2016,87(9):924-929.
[7] Amarenco P,Bogousslavsky J,Callahan 3rd A,et al. Highdose atorvastatin after stroke or transient ischemic attack[J]. N Engl J Med,2006,355(6):549-559.
[8] Goldstein LB,Amarenco P,Szarek M,et al. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study[J]. Neurology,2008,70(24):2364-2370.
[9] Chen Q,Shi X,Tan Q,et al. Simvastatin Promotes Hematoma Absorption and Reduces Hydrocephalus Following Intraventricular Hemorrhage in Part by Upregulating CD36[J].Transl Stroke Res,2017,8(4):362-373.
[10] Flores JJ,Klebe D,Rolland WB,et al. PPARgammainduced up regulation of CD36 enhances hematoma resolution and attenuates long-term neurological deficits after germinal matrix hemorrhage in neonatal rats[J]. Neurobiol Dis,2016,87:124-133.
[11] Gaist D,Goldstein LB,Cea Soriano L,et al. Statins and the Risk of Intracerebral Hemorrhage in Patients With Previous Ischemic Stroke or Transient Ischemic Attack[J]. Stroke,2017,48(12):3245-3251.
[12] Ferretti G,Bacchetti T,Banach M,et al. Impact of Statin Therapy on Plasma MMP-3, MMP-9, and TIMP-1Concentrations:A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials[J]. Angiology,2017,68(10):850-862.
[13] Jung JM,Choi JY,Kim HJ,et al. Statin use in spontaneous intracerebral hemorrhage:a systematic review and metaanalysis[J]. Int J Stroke,2015,10(suppl A100):10-17.
[14] Tapia-Perez JH,Yildiz OC,Schneider T,et al. Metaanalysis of Statin Use for the Acute Therapy of Spontaneous Intracerebral Hemorrhage[J]. J Stroke Cerebrovasc Dis,2015,24(11):2521-2526.
[15] Chen PS,Cheng CL,Chang YC,et al. Early statin therapy in patients with acute intracerebral hemorrhage without prior statin use[J]. Eur J Neurol,2015,22(5):773-780.
[16] Heart Protection Study. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions[J]. Lancet,2004,363(9411):757-767.
[17] Schmidt LB, Goertz S, Wohlfahrt J,et al.Recurrent intracerebral hemorrhage:associations with comorbidities and medicine with antithrombotic effects[J]. PLoS One, 2016, 11(11):e0166223.