大剂量阿托伐他汀对急性脑梗死经静脉重组组织型纤溶酶原激活剂溶栓效果的影响
|
摘要
目的探讨大剂量阿托伐他汀对急性脑梗死经静脉重组组织型纤溶酶原激活剂(rt-PA)溶栓效果的影响。方法 130例4.5h内接受静脉溶栓治疗的急性脑梗死患者中,40例rt-PA静脉溶栓联合阿托伐他汀治疗(观察组),90例仅rt-PA静脉溶栓治疗(对照组)。比较两组患者静脉溶栓的安全性及90d预后,分析影响急性脑梗死溶栓预后的因素。结果两组患者性别、年龄、吸烟、饮酒、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、脑卒中史以及患有糖尿病、高血压、动脉粥样硬化、心房颤动的比例等方面比较,差异均无统计学意义(均P>0.05)。观察组第90天溶栓预后良好率(70.0%)明显高于对照组(45.6%),差异有统计学意义(P<0.05)。二元logistic回归分析显示溶栓前NIHSS评分(OR=0.68,95%CI:0.581～0.796)是急性脑梗死患者静脉溶栓预后的危险因素,溶栓时联合使用大剂量阿托伐他汀(OR=2.848,95%CI:1.072～7.564)是急性脑梗死患者静脉溶栓预后的保护因素。结论在急性脑梗死患者静脉溶栓时应用大剂量阿托伐他汀可以改善患者预后。
Objective To evaluate the effect of high-dose atorvastatin on outcome of thrombolysis with recombinant tissue plasminogen activator(rt-PA) in acute cerebral infarction(ACI). Methods Date of 130 patients underwent intravenous thrombolysis within 4.5 hours of ACI were analyzed. Of them, 40 patients received atorvastatin with rt-PA intravenous thrombolysis(observation group) while the other 90 patients were not(control group). The safety and 90 days outcome of intravenous thrombolysis were compared between the two groups. The factors influencing the prognosis of ACI were analyzed. Results There was no significant difference of gender, age, smoking, drinking, National Institutes of Health Stroke Scale(NIHSS) score, history of stroke, proportion of diabetes, hypertension, atherosclerosis, and atrial fibrillation between the two groups(all P >0.05). The ratio of better outcome of thrombolysis at 90 th day was significantly higher in observation group(70.0%) than in control group(45.6%)(P <0.05). Binary logistic regression analysis showed that NIHSS score before thrombolysis was a risk factor(OR=0.68, 95% CI:0.581～0.796) and high dose atorvastatin was a protective factor(OR=2.848, 95% CI:1.072～7.564) for the outcome of intravenous thrombolysis in patients with ACI.Conclusion Application of high dosage of atorvastatin during intravenous thrombolysis may improve outcome of patients with ACI.
Objective To evaluate the effect of high-dose atorvastatin on outcome of thrombolysis with recombinant tissue plasminogen activator(rt-PA) in acute cerebral infarction(ACI). Methods Date of 130 patients underwent intravenous thrombolysis within 4.5 hours of ACI were analyzed. Of them, 40 patients received atorvastatin with rt-PA intravenous thrombolysis(observation group) while the other 90 patients were not(control group). The safety and 90 days outcome of intravenous thrombolysis were compared between the two groups. The factors influencing the prognosis of ACI were analyzed. Results There was no significant difference of gender, age, smoking, drinking, National Institutes of Health Stroke Scale(NIHSS) score, history of stroke, proportion of diabetes, hypertension, atherosclerosis, and atrial fibrillation between the two groups(all P >0.05). The ratio of better outcome of thrombolysis at 90 th day was significantly higher in observation group(70.0%) than in control group(45.6%)(P <0.05). Binary logistic regression analysis showed that NIHSS score before thrombolysis was a risk factor(OR=0.68, 95% CI:0.581～0.796) and high dose atorvastatin was a protective factor(OR=2.848, 95% CI:1.072～7.564) for the outcome of intravenous thrombolysis in patients with ACI.Conclusion Application of high dosage of atorvastatin during intravenous thrombolysis may improve outcome of patients with ACI.
引文
[1]Powers WJ,Derdeyn CP,Biller J,et al.2015 American Heart Association/American Stroke Association Focused Update of the 2013Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment∶A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J].Stroke,2015,46(10)∶3020-3035.DOI:10.1161/STR.0000000000000074.
[2]中华医学会神经病学分会.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南(2010)[J].中国临床医生,2011,39(11)∶68-74.DOI∶10.3969/j.issn.1008-1089.2011.11.028.
[3]Zhang L,Chopp M,Jia L,et al.Atorvastatin extends the therapeutic window for t PA to 6h after the onset of embolic stroke in rats[J].J Cereb Blood Flow Metab,2009,29(11)∶1816-1824.DOI∶10.1038/jcbfm.2009.105.
[4]Miedema I,Uyttenboogaart M,Koopman K,et al.Statin use and functional outcome after tissue plasminogen activator treatment in acute ischaemic stroke[J].Cerebrovasc Dis,2010,29(3)∶263-167.DOI∶10.1159/000275500.
[5]Engelter ST,Soinne L,Ringleb P,et al.IV thrombolysis and statins[J].Neurology,2011,77(9)∶888-895.DOI∶10.1212/WNL.0b013e31822c9135.
[6]Trapani L,Segatto M,Incerpi S,et al.3-Hydroxy-3-methylglutaryl coenzyme A reductase regulation by antioxidant compounds∶new therapeutic tools for hypercholesterolemia[J].Curr Mol Med,2011,11(9)∶790-797.DOI∶10.2174/156652411798062403.
[7]Powers WJ,Rabinstein AA,Ackerson T,et al.2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke∶AGuideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J].Stroke,2018,49(3)∶e46-e110.DOI∶10.1161/STR.0000000000000158.
[8]霍晓川,高峰.急性缺血性卒中血管内治疗中国指南2018[J].中国卒中杂志,2018,13(7)∶706-729.DOI∶10.3969/j.issn.1673-5765.2018.07.014.
[9]Karlinski M,Kobayashi A,Czlonkowska A,et al.Intravenous Thrombolysis for Stroke Recurring Within 3 Months From the Previous Event[J].Stroke,2015,46(11)∶3184-3189.DOI∶10.1161/STROKEAHA.115.010420.
[10]Ni CD,Callaly EL,Duggan J,et al.Association between acute statin therapy,survival,and improved functional outcome after ischemic stroke∶the North Dublin Population Stroke Study[J].Stroke,2011,42(4)∶1021-1029.DOI∶10.1161/STROKEAHA.110.596734.
[11]Flint AC,Kamel H,Navi BB,et al.Statin use during ischemic stroke hospitalization is strongly associated with improved poststroke survival[J].Stroke,2012,43(1)∶147-154.DOI∶10.1161/STROKEAHA.111.627729.
[12]Tsivgoulis G,Kadlecova P,Kobayashi A,et al.Safety of Statin Pretreatment in Intravenous Thrombolysis for Acute Ischemic Stroke[J].Stroke,2015,46(9)∶2681-2684.DOI∶10.1161/STROKEAHA.115.010244.
[13]Campos M,Garcia-Bonilla L,Hernandez-Guillamon M,et al.Combining statins with tissue plasminogen activator treatment after experimental and human stroke∶a safety study on hemorrhagic transformation[J].CNS Neurosci Ther,2013,19(11)∶863-870.DOI∶10.1111/cns.12181.
[14]Fisher M,Moonis M.Neuroprotective effects of statins∶evidence from preclinical and clinical studies[J].Curr Treat Options Cardiovasc Med,2012,14(3)∶252-259.DOI∶10.1007/s11936-012-0174-9.
[15]林建武,周翼.阿托伐他汀钙对脑梗死急性期患者炎性因子表达及神经功能缺损的影响[J].中国生化药物杂志,2016,36(2)∶97-99.
[16]周红霞,王兴元,范利娟,等.阿托伐他汀在急性缺血性脑卒中患者中的临床研究[J].中国临床药理学杂志,2016,32(1)∶72-74.DOI∶10.13699/j.cnki.1001-6821.2016.01.023.
[17]林文东,李振喜,施水液,等.阿托伐他汀对大鼠脑缺血再灌注后脑组织IL-17、IL-10、TNF-α表达的影响[J].中风与神经疾病杂志,2018,35(6)∶504-507.
[18]孙秀云.不同剂量阿托伐他汀钙治疗急性脑梗死临床观察[J].中国实用神经疾病杂志,2018,21(3)∶290-293.DOI∶10.12083/SYSJ.2018.03.074.
[19]麦宜准,周祥富,梁健,等.阿托伐他汀钙对急性脑梗死患者的治疗效果及预防作用[J].中国实用神经疾病杂志,2015,18(21)∶74-75.DOI∶10.3969/j.issn.1673-5110.2015.21.050.
[2]中华医学会神经病学分会.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南(2010)[J].中国临床医生,2011,39(11)∶68-74.DOI∶10.3969/j.issn.1008-1089.2011.11.028.
[3]Zhang L,Chopp M,Jia L,et al.Atorvastatin extends the therapeutic window for t PA to 6h after the onset of embolic stroke in rats[J].J Cereb Blood Flow Metab,2009,29(11)∶1816-1824.DOI∶10.1038/jcbfm.2009.105.
[4]Miedema I,Uyttenboogaart M,Koopman K,et al.Statin use and functional outcome after tissue plasminogen activator treatment in acute ischaemic stroke[J].Cerebrovasc Dis,2010,29(3)∶263-167.DOI∶10.1159/000275500.
[5]Engelter ST,Soinne L,Ringleb P,et al.IV thrombolysis and statins[J].Neurology,2011,77(9)∶888-895.DOI∶10.1212/WNL.0b013e31822c9135.
[6]Trapani L,Segatto M,Incerpi S,et al.3-Hydroxy-3-methylglutaryl coenzyme A reductase regulation by antioxidant compounds∶new therapeutic tools for hypercholesterolemia[J].Curr Mol Med,2011,11(9)∶790-797.DOI∶10.2174/156652411798062403.
[7]Powers WJ,Rabinstein AA,Ackerson T,et al.2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke∶AGuideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J].Stroke,2018,49(3)∶e46-e110.DOI∶10.1161/STR.0000000000000158.
[8]霍晓川,高峰.急性缺血性卒中血管内治疗中国指南2018[J].中国卒中杂志,2018,13(7)∶706-729.DOI∶10.3969/j.issn.1673-5765.2018.07.014.
[9]Karlinski M,Kobayashi A,Czlonkowska A,et al.Intravenous Thrombolysis for Stroke Recurring Within 3 Months From the Previous Event[J].Stroke,2015,46(11)∶3184-3189.DOI∶10.1161/STROKEAHA.115.010420.
[10]Ni CD,Callaly EL,Duggan J,et al.Association between acute statin therapy,survival,and improved functional outcome after ischemic stroke∶the North Dublin Population Stroke Study[J].Stroke,2011,42(4)∶1021-1029.DOI∶10.1161/STROKEAHA.110.596734.
[11]Flint AC,Kamel H,Navi BB,et al.Statin use during ischemic stroke hospitalization is strongly associated with improved poststroke survival[J].Stroke,2012,43(1)∶147-154.DOI∶10.1161/STROKEAHA.111.627729.
[12]Tsivgoulis G,Kadlecova P,Kobayashi A,et al.Safety of Statin Pretreatment in Intravenous Thrombolysis for Acute Ischemic Stroke[J].Stroke,2015,46(9)∶2681-2684.DOI∶10.1161/STROKEAHA.115.010244.
[13]Campos M,Garcia-Bonilla L,Hernandez-Guillamon M,et al.Combining statins with tissue plasminogen activator treatment after experimental and human stroke∶a safety study on hemorrhagic transformation[J].CNS Neurosci Ther,2013,19(11)∶863-870.DOI∶10.1111/cns.12181.
[14]Fisher M,Moonis M.Neuroprotective effects of statins∶evidence from preclinical and clinical studies[J].Curr Treat Options Cardiovasc Med,2012,14(3)∶252-259.DOI∶10.1007/s11936-012-0174-9.
[15]林建武,周翼.阿托伐他汀钙对脑梗死急性期患者炎性因子表达及神经功能缺损的影响[J].中国生化药物杂志,2016,36(2)∶97-99.
[16]周红霞,王兴元,范利娟,等.阿托伐他汀在急性缺血性脑卒中患者中的临床研究[J].中国临床药理学杂志,2016,32(1)∶72-74.DOI∶10.13699/j.cnki.1001-6821.2016.01.023.
[17]林文东,李振喜,施水液,等.阿托伐他汀对大鼠脑缺血再灌注后脑组织IL-17、IL-10、TNF-α表达的影响[J].中风与神经疾病杂志,2018,35(6)∶504-507.
[18]孙秀云.不同剂量阿托伐他汀钙治疗急性脑梗死临床观察[J].中国实用神经疾病杂志,2018,21(3)∶290-293.DOI∶10.12083/SYSJ.2018.03.074.
[19]麦宜准,周祥富,梁健,等.阿托伐他汀钙对急性脑梗死患者的治疗效果及预防作用[J].中国实用神经疾病杂志,2015,18(21)∶74-75.DOI∶10.3969/j.issn.1673-5110.2015.21.050.