强化降脂治疗对脑出血临床结果的影响  

The impact of intensive-lipid-lowering therapy on the outcomes of intracerebral hemorrhage

作　　者：唐天萍[1] 张立功[1] 赵性泉[2] 刘诗蒙 Tang Tianping;Zhang Ligong;Zhao Xingquan;Liu Shimeng(Department of Neurology,the Shengli Oilfiled Central Hospital,31 Jinan Road,Dongying,Shandong 257000,China)

机构地区：[1]东营市胜利油田中心医院神经内科,山东257031 [2]首都医科大学附属北京天坛医院神经病学中心 [3]首都医科大学宣武医院神经内科

出　　处：《脑与神经疾病杂志》2021年第11期661-665,共5页Journal of Brain and Nervous Diseases

基　　金：国家自然科学基金青年科学基金项目(82001242)。

摘　　要：目的以低密度脂蛋白胆固醇(LDL-C)<1.80 mmol·L^(-1)为目标值的强化降脂治疗(ILLT)是缺血性脑卒中二级预防的重要策略。本研究旨在探讨ILLT对ICH临床结局的影响。方法分析首都医科大学宣武医院高级卒中中心2013~2018年和山东省胜利油田中心医院高级卒中中心2017~2019年连续收住院的合并陈旧性脑梗死病史的ICH患者。根据患者基线LDL-C水平对患者进行分类:<1.80 mmol·L^(-1)和≥1.80 mmol·L^(-1);比较两组患者ICH的临床预后。采用重复测量多元线性混合效应模型评估LDL-C水平与美国国立卫生院院脑卒中量表(NIHSS)评分改善情况的相关性。结果本研究共纳入292例患者:51例LDL-C<1.80 mmol·L^(-1),241例LDL-C≥1.80 mmol·L^(-1)。两组间人口统计学特征和血管危险因素无统计学意义(均P<0.05)。基线NIHSS评分(9vs.8,P=0.65)和ICH评分(1 vs.1,P=0.52)无统计学差异。而LDL-C≥1.80 mmol·L^(-1)组患者发病时出现意识障碍的风险较高(47%vs.31%,P=0.03)。出院时ICH的临床结局相似,但LDL-C≥1.80 mmol·L^(-1)组的患者出院时NIHSS评分有显著改善(参考区间:-2.4,95%CI:-4.3--0.2),而LDL-C<1.80 mmol·L^(-1)组患者无显著变化(参考区间:-1.3,95%CI:-5.9-3.5)。结论ILLT可能影响ICH患者神经功能缺损改善的趋势。Objective The intensive lipid-lowering therapy(ILLT),targeting a low-density lipoprotein cholesterol(LDL-C)<1.80 mmol·L^(-1),was a crucial strategy for the secondary prevention of cerebrovascular diseases.But the associations between ILLT and the outcomes after intracerebral hemorrhage(ICH)were unclear;the study was to investigate the associations between ILLT and the outcomes of ICH.Methods Data of the consecutive patients with acute ICH and the past medical histories of ischemic stroke from the Comprehensive Stroke Center,Xuanwu Hospital,Capital Medical University(2013-2018)and the Comprehensive Stroke Center,Shenli Oilfield Central Hospital(2017-2019)were analyzed.The study patients were classified according to their baseline LDL-C levels:<1.80 mmol·L^(-1)vs.≥1.80 mmol·L^(-1).The outcomes of ICH were compared between the two groups.Multivariate linear mixed effect model with repeated measures were used to determine the associations between LDL-C levels and the change in NIHSS scores.Results A total of 292 patients were included in the study,51 of them had LDL-C<1.80 mmol·L^(-1)and 241 had LDL-C≥1.80 mmol·L^(-1).We did not test any significant differences regarding the demographic characteristics or vascular risk factors.Medians of the baseline National Institutes of Health Stroke Scale(NIHSS)scores(9 vs.8,P=0.65)and ICH scores(1 vs.1,P=0.52)were similar.But the patients with LDL-C≥1.80 mmol·L^(-1)had higher risks of consciousness impairments(47%vs.31%,P=0.03).Outcomes of the hemorrhagic stroke at discharge were similar,except the patients with LDL-C≥1.80 mmol·L^(-1)had significant improvements in their NIHSS scores at discharge(estimated change in means:-2.4,95%CI:-4.3--0.2),while patients with LDL-C<1.80 mmol·L^(-1)did not(estimated change in means:-1.3,95%CI:-5.9-3.5).Conclusion ILLT achieved LDL-C<1.80 mmol·L^(-1)was associated with limited improvements in the neurological deficits in the patients with ICH.

关 键 词：强化降脂治疗 脑出血 低密度胆固醇脂蛋白 临床结局 

分 类 号：R743.34[医药卫生—神经病学与精神病学]