早期他汀类药物治疗在急性前循环大血管闭塞性卒中血管内治疗患者中的多中心研究  

Multicenter study of early statin therapy in patients with endovascular treatment in acute anterior circulation large vessel occlusive stroke

作　　者：刘瀚圣 龚自力 资文杰 邱忠明 李凤利 岳成松 杨峻 刘文华 时忠华[3] 杨世泉[4] 张帅[5] 王力[6] 白永杰[7] 王守春[8] 吴德平 陈路明 余鹏霄 罗伟东 刘帅 Liu Hansheng;Gong Zili;Zi Wenjie;Qiu Zhongming;Li Fengli;Yue Chengsong;Yang Jun;Liu Wenhua;Shi Zhonghua;Yang Shiquan;Zhang Shuai;Wang Li;Bai Yongjie;Wang Shouchun;Wu Deping;Chen Luming;Yu Pengxiao;Luo Weidong;Liu Shuai(Department of Neurology,the Second Affiliated Hospital,Army Medical University,Chongqing 400037,China;Department of Neurology,Wuhan First Hospital,Wuhan 430022,China;Department of Neurosurgery,NO.904 Hospital of Chinese People's Liberation,Jiangsu,Wuxi 214008,China;Department of Neurology,NO.902 Hospital of Chinese People's Liberation,Anhui,Bengbu 233010,China;Department of Neurology,the First People's Hospital of Yangzhou,Jiangsu,Yangzhou 225001,China;Department of Neurology,the Third People's Hospital of Zigong,Sichuan,Zigong 643000,China;Department of Neurology,the First Affiliated Hospital of Henan Science and Technology University,Henan,Luoyang 471000,China;Department of Neurology,the First Hospital of Jilin University,Changchun 130000,China)

机构地区：[1]陆军军医大学第二附属医院神经内科,重庆400037 [2]武汉市第一医院神经内科,武汉430022 [3]中国人民解放军第九〇四医院神经外科,江苏无锡214008 [4]中国人民解放军第九〇二医院神经内科,安徽蚌埠233010 [5]扬州市第一人民医院神经内科,江苏扬州225001 [6]自贡市第三人民医院神经内科,四川自贡643000 [7]河南科技大学第一附属医院神经内科,河南洛阳471000 [8]吉林大学第一医院神经内科,长春130000

出　　处：《中国医学前沿杂志（电子版）》2020年第3期83-89,共7页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：重庆市卫健委科研课题(2019ZX001)。

摘　　要：目的探讨急性前循环大血管闭塞性卒中血管内治疗患者早期联合他汀类药物治疗的安全性和有效性。方法回顾性分析2013年8月至2018年5月陆军军医大学第二附属医院、武汉市第一医院、中国人民解放军第九〇四医院、中国人民解放军第九〇二医院、扬州市第一人民医院、自贡市第三人民医院、河南科技大学第一附属医院、吉林大学第一医院8家卒中中心收治的急性前循环大血管闭塞性卒中行血管内治疗患者的临床资料。根据患者是否早期使用他汀类药物治疗将其分为他汀组和非他汀组,采用倾向评分匹配对两组患者进行匹配,观察两组患者90 d改良Rankin量表(modified Rankin scale,mRS)评分、90 d死亡率、症状性颅内出血发生率,并采用多因素Logistic回归分析探讨影响急性前循环大血管闭塞性卒中血管内治疗患者神经功能预后的相关因素。结果本研究共纳入247例患者,其中他汀组200例(81.0%)、非他汀组47例(19.0%),经倾向评分匹配1∶1匹配后,他汀组和非他汀组各43例。倾向评分匹配后,他汀组90 d mRS评分0~2分患者占比显著高于非他汀组(P<0.05),90 d死亡率显著低于非他汀组(P<0.05),两组患者症状性颅内出血发生率比较差异无统计学意义(P>0.05)。多因素Logistic回归分析提示,早期他汀类药物治疗、侧支循环均为急性前循环大血管闭塞性卒中血管内治疗患者神经功能预后的独立预测因素(均P<0.05)。结论急性前循环大血管闭塞性卒中血管内治疗早期联合他汀类药物治疗能改善患者的近期预后,且安全性高,早期他汀类药物治疗是患者神经功能预后的独立保护因素。Objective To research the efficacy and safety of early statin therapy in patients with endovascular treatment in acute anterior circulation large vessel occlusive stroke.Method A retrospective study of clinical data of patients with endovascular treatment in acute anterior circulation large vessel occlusive stroke in the Second Affiliated Hospital,Army Medical University,Wuhan First Hospital,NO.904 Hospital of Chinese People's Liberation,NO.902 Hospital of Chinese People's Liberation,the First People's Hospital of Yangzhou,the Third People's Hospital of Zigong,the First Affiliated Hospital of Henan Science and Technology University and the First Hospital of Jilin University from August 2013 to May 2018 were performed.According to whether early using statin,patients were divided into statin group and non-statin group.The propensity matching analysis was used to match the two groups of patients.The 90-day modified Rankin scale(mRS)score,90-day mortality,and symptomatic intracranial hemorrhage were compared between the two groups.Multivariate Logistic regression analysis were used to explore the relevant factors affecting the neurological prognosis of patients with endovascular treatment in acute anterior circulation large vessel occlusive stroke.Result A total of 247 patients were enrolled,including 200 cases(81.0%)in statin group and 47 cases(19.0%)in non-statin group.After 1∶1 matching in the propensity matching analysis,each group enrolled 43 patients.The proportion of patients with 90-day mRS score of 0~2 points in statin group was significantly higher than that of non-statin group(P<0.05),and the 90-day mortality rate was significantly lower than that of non-statin group(P<0.05),there was no significant difference in the incidence of symptomatic intracranial hemorrhage between the two groups(P>0.05).Multivariate Logistic regression analysis indicated that early statin therapy and collateral circulation were independent predictors affecting neurological prognosis in acute anterior circulation large vessel occ

关 键 词：急性缺血性脑卒中 前循环大血管闭塞 血管内治疗 他汀治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]