阿托伐他汀对缺血性脑卒中患者医院获得性肺炎的影响  

Influence of atorvastatin on hospital acquired pneumonia in patients with acute ischemic stroke

作　　者：余跃天[1] 朱琤[2] 毛恩强[2] 舒良[3] 殷荣[1] 李昱洁[1] 刘春艳 曹建国[1] 皋源[1] 

机构地区：[1]上海交通大学医学院附属仁济医院重症医学科,上海200001 [2]上海交通大学医学院附属瑞金医院急诊科,上海200025 [3]上海交通大学医学院附属第九人民医院神经内科,上海200011 [4]上海市闵行区中心医院急诊科,上海201100

出　　处：《诊断学理论与实践》2015年第2期169-174,共6页Journal of Diagnostics Concepts & Practice

基　　金：上海市卫生局青年基金(20114Y119)

摘　　要：目的：探讨既往长期服用阿托伐他汀对于缺血性脑卒中患者医院获得性肺炎的发生率及其炎性标志物的影响。方法：选择492例确诊为急性缺血性脑卒中且格拉斯哥昏迷评分≤8分的患者,根据患者发病入院前是否连续服用阿托伐他汀大于30 d,分为先前服药组（PG组,n=268）及先前未服药组（NG组,n=224）。在ICU住院期间,纳入患者每晚均服用阿托伐他汀20 mg。记录并比较2组患者的医院获得性肺炎发病率及28 d病死率,同时比较其炎性标志物（白细胞、降钙素原、肿瘤坏死因子-α、白细胞介素-6）的演变趋势及他汀相关不良事件的发生率。结果：PG组与NG组比较,患者入院期间的医院获得性肺炎发生率（25.74%比24.55%,P〉0.05）、28 d病死率（50.72%比58.18%,P〉0.05）及呼吸机相关性肺炎的发生率（41.94%比46.24%,P〉0.05）差异均无统计学意义。但PG组患者发生呼吸机相关性肺炎后的病死率显著减少（36.54%比58.14%,P=0.041）,且是保护性因素（HR=0.564;95%CI,0.310~0.825,P=0.038）;而PG组患者发生呼吸机相关性肺炎后,其血清肿瘤坏死因子-α、白细胞介素-6浓度亦均低于NG组（P〈0.01）。结论：先前服用阿托伐他汀可降低急性缺血性脑卒中患者罹患呼吸机相关性肺炎后的病死率,并下调患者血清肿瘤坏死因子-α、白细胞介素-6的水平。Objective： To study the influence of long-term atorvastatin treatment prior to ischemic stroke on the incidence of hospitalacquired pneumonia（HAP） and levels of inflammatory markers. Methods： A total of 492 patients with acute ischemic stroke and Glasgow Coma Scale≤8 from 4 teaching hospitals were enrolled. Patients with prior atorvastatin treatment were assigned to atorvastatin treatment group（n=268, PG）, and the others were assigned to no treatment group（n=224, NG）. All the patients were given 20 mg atorvastatin every night during their stay in intensive care unit. Incidence of HAP and 28-day mortality were calculated. Levels of inflammatory markers [white blood cell（WBC）, procalcitonin（PCT）, tumor necrosis factor-alpha（ TNF-α）, interleukin-6（IL-6）] in blood serum were detected. Adverse events related to atorvastatin treatment were documented. Results： There were no significant differences in incidence of HAP and 28-day mortality rate between PG and NG groups（25.74% vs. 24.55%, P0.05; 50.72% vs. 58.18%, P0.05, respectively）. The incidence of ventilator associated pneumonia（VAP） was not significantly different between the two groups（41.94% vs46.24%, P0.05）. However, prior atorvastatin treatment did influence the mortality of VAP（36.54% vs 58.14%, P=0.041）and was proved to be a protective factor（HR=0.564; 95% CI, 0.310-0.825, P=0.038）. Levels of TNF-α and IL-6 in VAP patients were lower in PG group than in NG group（P0.01）. Conclusions： Prior atorvastatin treatment can reduce mortality of VAP in patients with ischemic stroke, and down-regulates serum levels of TNF-α and IL-6.

关 键 词：他汀 急性缺血性脑卒中 医院获得性肺炎 呼吸机相关性肺炎 炎性标志物 

分 类 号：R563.19[医药卫生—呼吸系统]