住院期间他汀类药物治疗对伴有慢性肾脏病的急性缺血性卒中患者短期卒中复发的影响  

Effect of Statin Use During Hospitalization on Short-term Stroke Recurrence in Acute Ischemic Stroke with Chronic Kidney Disease in Chinese Population

作　　者：吕微 姜勇 张心邈 荆京 孟霞 周脉耕[2] LYU Wei;JIANG Yong;ZHANG Xin-Miao;JING Jing;MENG Xia;ZHOU Mai-Geng(Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing 100050, China;The National Center for Chronic and Noncommunicable Disease Control and Prevention （NCNCD）, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京天坛医院国家神经系统疾病临床医学研究中心,北京100050 [2]中国疾病预防控制中心慢性非传染性疾病预防控制中心

出　　处：《中国卒中杂志》2018年第6期542-549,共8页Chinese Journal of Stroke

基　　金：国家科技支撑计划项目"中国国家卒中登记研究(CNSR)"课题(2006BA101A11);国家科技支撑计划项目"重大慢病国家注册登记研究"课题(2015BAI12B02)

摘　　要：目的分析住院期间使用他汀类药物降低伴有慢性肾病(chronic kidney disease,CKD)的急性缺血性卒中患者短期复发的效果。方法选取中国国家卒中登记研究(China National Stroke Registry,CNSR)中首次发病,且发病前未服用他汀类药物治疗的缺血性卒中患者作为研究对象。根据肾小球滤过率(estimated glomerular filtration rate,e GFR)将患者分成三组,肾功能正常组[eGFR≥90 ml/(min·1.73 m^2)]、轻度CKD组[60 ml/(min·1.73 m^2)≤eGFR<90 ml/(min·1.73 m^2)]和中度CKD组[eGFR<60 ml/(min·1.73 m^2)]。采用多因素Logistic回归分析,分析住院期间他汀类药物治疗与不同肾脏功能缺血性卒中患者3个月卒中复发的相关性。结果在5951例患者中,2595例(43.6%)患者卒中后住院期间使用他汀类药物,与未使用他汀类药物治疗组相比,住院期间使用他汀类药物可以降低伴有CKD的缺血性卒中患者的3个月卒中复发风险,包括轻度CKD组[比值比(odds ratios,OR)0.69,95%可信区间(confidence interval,CI)0.50~0.95,P=0.02]和中度CKD组(OR 0.48,95%CI 0.28~0.83,P=0.009)。然而在肾功能正常组,他汀类药物治疗无明显疗效(OR 0.80,95%CI 0.60~1.06,P=0.12)。结论在中国人群中,住院期间使用他汀类药物可降低伴有轻度CKD和中度CKD的缺血性卒中患者3个月卒中复发风险,但不能降低正常肾脏功能缺血性卒中患者卒中复发风险,该结论应在更大样本人群中进一步验证。Objective We investigated the effect of statin use during hospitalization in reducing short-term stroke recurrence of patients with acute ischemic stroke and chronic kidney diseases（CKD）.Methods Data of first-ever ischemic stroke patients without a history of pre-stroke statin use was derived from the China National Stroke Registry（CNSR）.Patients were stratified according to estimated glomerular filtration rate（e GFR）：normal renal function[e GFR≥90 ml/（min·1.73 m^2）],mild CKD[60 ml/（min·1.73 m^2）≤e GFR90 ml/（min·1.73 m^2）]and moderate CKD[e GFR60ml/（min·1.73 m^2）].Multi-factors logistic regression analysis was used to evaluate the association between statin use during hospitalization and stroke recurrence with different renal functions at3-month follow-up.Results Among 5951 patients included,2595（43.6%）patients were on statin use during hospitalization after stroke.Compared with non-statin group,statin use during hospitalization was associated with decreased stroke recurrence in patients with mild CKD[odds ratios（OR）0.69,95%confidence interval（CI）0.50-0.95,P=0.02]and moderate CKD（OR 0.48,95%CI 0.28-0.83,P=0.009）at 3-month follow-up,respectively.Whereas in patients with normal renal function,no significant benefit from statin therapy was detected（OR 0.80,95%CI 0.60-1.06,P=0.12）.Conclusion Statin use during hospitalization was associated with decreased stroke recurrence in ischemic stroke patients with mild and moderate CKD at 3-month follow-up,but not in patients with normal renal function in Chinese population.Further studies are needed to confirm this finding.

关 键 词：慢性肾脏病 急性缺血性卒中 他汀类药物治疗 卒中复发 

分 类 号：R692[医药卫生—泌尿科学] R743.3[医药卫生—外科学]