依洛尤单抗对急性前循环缺血性脑梗死患者早期颅内出血风险的影响  

Effect of evolocumab on risk of early intracerebral hemorrhage in patients with acute anterior circulation ischemic cerebral infarction

作　　者：赵娜 张婷[1] 杨云[1] 廖海兵 黎洵 于淼 刘然 岳伟[1] Zhao Na;Zhang Ting;Yang Yun;Liao Haibing;Li Xun;Yu Miao;Liu Ran;Yue Wei(Department of Neurology,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院神经内科,天津300350

出　　处：《药物不良反应杂志》2021年第5期241-246,共6页Adverse Drug Reactions Journal

摘　　要：目的探讨依洛尤单抗对急性前循环脑梗死患者早期颅内出血风险的影响。方法收集2019年1月至2020年9月在发病48 h内收住天津市环湖医院的急性前循环缺血性脑梗死患者的病历资料进行回顾性分析。患者入院当日均开始他汀类药物降脂治疗,空腹低密度脂蛋白胆固醇(LDL-c)>3.37 mmol/L者联用依洛尤单抗。单独应用他汀类药物者纳入他汀组,联合应用依洛尤单抗者纳入联合组,比较2组患者入院第2周降脂治疗达标(LDL-c<1.70 mmol/L)情况和入院后2周内颅内出血事件发生情况。根据是否发生颅内出血将患者分为出血组和未出血组,比较2组患者基本情况,合并疾病情况,脑梗死病因分型,降脂方案,入院时美国国立卫生研究院卒中量表(NIHSS)评分,血压、血脂水平以及降脂治疗第2周血脂水平等临床特征,将组间比较P<0.05的因素纳入多因素logistic回归分析,计算比值比(OR)及其95%置信区间(CI),分析颅内出血的危险因素。结果纳入分析的患者共437例,他汀组358例(81.9%),联合组79例(18.1%);2组患者基本情况、合并疾病情况、脑梗死病因分型、降脂方案、入院时NIHSS评分、血压等临床特征比较的差异均无统计学意义(均P>0.05);他汀组基线总胆固醇(TC)、三酰甘油(TG)、LDL-c、高密度脂蛋白胆固醇(HDL-c)水平均低于联合组(TC:P<0.001,TG:P<0.001,LDL-c:P=0.004,HDL-c:P=0.024)。降脂治疗第2周,他汀组和联合组患者LDL-c、TC水平均较治疗前下降,但他汀组治疗前、后LDL-c和TC水平的差值均明显低于联合组[LDL-c:(0.66±0.91)mmol/L比(2.58±0.38)mmol/L,P<0.001;TC:(0.37±0.18)mmol/L比(1.94±0.44)mmol/L,P<0.001]。联合组降脂治疗达标率明显高于他汀组[87.3%(69/79)比9.7%(37/358),P<0.001]。入院后2周内他汀组和联合组患者颅内出血发生率分别为12.0%(43/358)和13.9%(11/79)。多因素logistic回归分析结果显示,合并心房颤动(OR=3.054,95%CI:1.402~6.651,P=0.005)、入院时Objective To explore the effect of evolocumab on the risk of early intracranial hemorrhage in patients with acute anterior circulation ischemic cerebral infarction.Methods The medical records of patients with acute anterior circulation ischemic cerebral infarction who were admitted to Tianjin Huanhu Hospital within 48 hours of onset from January 2019 to September 2020 were collected and analyzed retrospectively.On the day of admission,all patients were given statin lipid-lowering therapy and the patients with fasting low density lipoprotein cholesterol(LDL-c)>3.37 mmol/L received combination therapy with statin and evolocumab.The patients who used statins alone were enrolled in the statins group and those with combined application of evolocumab were enrolled in the combination group.The situation of blood lipid level up to standard(LDL-c<1.70 mmol/L)and the occurrence of intracranial hemorrhage in the second week after admission were compared between the 2 groups.The patients were divided into bleeding group and non-bleeding group according to the occurrence of intracranial hemorrhage.The basic information,combined diseases,etiological classification of cerebral infarction,lipid-lowering program,National Institute of Health Stroke Scale(NIHSS)score on admission,blood pressure,blood lipid level,and blood lipid level in the second week of lipid-lowering treatment between the 2 groups were compared.The factors with P<0.05 were enrolled in the multivariate logistic regression analysis,odds ratio(OR)and its 95%confidence interval(CI)were calculated,and the risk factors of intracranial hemorrhage were analyzed.Results A total of 437 patients were enrolled in the analysis,including 358(81.9%)in the statins group and 79(18.1%)in the combination group.The differences in basic information,combined diseases,etiological classification of cerebral infarction,lipid-lowering program,NIHSS score on admission,blood pressure,and other clinical features between the 2 groups were not statistically significant(all P>0.05).The baselin

关 键 词：脑梗死 血脂异常 颅内出血 他汀类 依洛尤单抗 

分 类 号：R743.33[医药卫生—神经病学与精神病学]