阿托伐他汀对急性缺血性卒中梗死体积的影响

目的:探讨他汀在缺血性卒中急性期对梗死体积的影响。方法:前瞻性的纳入24h内急诊入院的急性缺血性卒中患者,随机分成他汀组(40mg/d,2周)和对照组。发病1周内,进行头颅磁共振(MRI)检查,并在3个月随访时予以复查,分析两组患者梗死体积变化的情况,并采用Logistic回归分析影响梗死体积变化的因素。同时进行血脂、炎症因子和神经功能评分等评估。结果:共39例患者接受了2次头颅MRI检查。其中阿托伐他汀组患者20例,对照组患者19例。两组患者的梗死体积变化率差异有统计学意义(P<0.01)。阿托伐他汀组患者发病后3个月梗死体积较发病时减少的比例显著高于对照组(71.4%对28.6%,P<0.05)。多因素Lo-gistic回归分析,显示不用他汀治疗以及入院时NIHSS评分高是梗死体积增大的独立危险因素。结论:缺血性卒中急性期使用他汀可能有利于患者梗死体积的局限。梗死体积的变化可能成为临床神经功能改善的一个补充观察指标来进一步评价药物干预的效果。他汀类药物是否能局限脑梗死体积和改善临床预后仍需进一步临床研究证实。

Impact of atorvastatin on infarct volume of acuteischemic stroke statinnaive

Objective：We examined the efficiency of statin on restricting infarction volume among acute ischemic stroke patients. Method： Patients with acute ischemic stroke symptom onset 24 hours or less were prospectively enrolled and randomized to atorvastatin （40 rag/d） or control group for 2 weeks. MRI were obtained at 1 week and 3 months after stroke onset. In addition, lipid level, inflammation markers and neurological function outcome were also evaluated. Result：Thirty-nine patients were taken MRI twice, 20 of whom received atorvastatin and of whom were in control group. There was significant difference between two groups on infarct volume change rate （P=0. 002）. Compared with patients from control group, atorvastatin patients tended to have increased frequency of in- farction volume decrement at 3 months after onset （71.4~ vs 27.8~, P=0. 010）. In multivariate logistic regres- sion, no statin treatment in acute phase and high admission NIHSS were independent risk factors of increased in- farct volume. Conelusion：These present preliminary results suggest that statin treatment in the acute phase of ischemic stroke may decrease infarction lesions. It can he a complementary observation indicator to evaluate the effi- ciency of drug intervention. However, more sophisticated experiments and large clinical trials are needed to con- firm whether neuroprotective effects might be obtained by statins in the acute stage of ischemic stroke.