早期与延迟他汀治疗对急性缺血性卒中患者血清超敏C-反应蛋白及预后的影响

目的 探讨早期与延迟他汀治疗对急性缺血性卒中（AIS）患者血清超敏C-反应蛋白（hs-CRP）和预后的影响。方法 选择2016年10月至2018年1月安徽省立医院神经内科住院的AIS患者267例,采用随机数字表法分为早期他汀治疗组（n=134）与延迟他汀治疗组（n=133）。两组患者分别于发病24 h内和第7天开始接受他汀治疗。采用美国国立卫生研究院卒中量表评价入院时和发病第7天患者神经功能缺损情况;使用改良Rankin量表（mRS）评定第90天临床预后;通过胶乳增强免疫比浊法测定患者发病24 h内、第7天、第90天的hs-CRP水平。比较两组患者血清hs-CRP的变化、急性期神经功能的改善及90天预后良好比例,并分析延迟他汀治疗与预后不良的相关性。结果 早期他汀治疗组患者第7天hs-CRP水平较发病24 h内下降[（5.02±0.65）mg/L vs（6.45±0.59）mg/L],差异有统计学意义（P<0.05）。早期他汀治疗组患者90天mRS评分预后良好的比例高于延迟他汀治疗组[48.51%vs 36.09%],差异有统计学意义（P<0.05）。logstics回归分析显示,第7天hs-CRP水平、延迟治疗是预后不良的影响因素（P<0.05）。结论 早期他汀治疗可降低AIS患者急性期血清hs-CRP浓度,并可改善预后。

Effects of early and delayed statin therapy on serum high-sensitivity C-reactive protein level and prognosis in patients with acute ischemic stroke

Objective To investigate the effects of early and delayed statin therapy on serum hyper sensitivity C-reactive protein levels and prognosis in patients with acute ischemic stroke (AIS). Methods A total of 267 AIS patients admitted to the Department of Neurology, Anhui Provincial Hospital from Oct. 2016 to Jan. 2018 were recruited.The patients were divided into early statin treatment group (n=134) and delayed statin treatment group (n=133) by random number table method.The two groups of patients respectively received statin within 24 hours and 7th day after the AIS. The National Institutes of Health Stroke Scale was used to evaluate neurological deficits on admission and 7th day after onset. Functional outcomes were assessed by the modified Rankin Scale (mRS) on 90th day. The serum hs-CRP was measured by latex-enhanced immunoturbidimetric assay within 24 hours, 7 days, 90 days, respectively.The changes in serum hs-CRP levels were compared at different time points. The improvement of neurological function in acute stage and the proportion of mRS scores with good outcome were compared among the two groups, and Logistic regression was used to explore the relationship between delayed statin treatment and poor prognosis. Results The serum hs-CRP levels on 7th day in the early statin treatment group was lower than that within 24 hours of onset[(5.02±0.65)mg/L vs(6.45±0.59)mg/L](P< 0.05). The proportion of good outcome on 90th day in the early statin treatment group was higher than that of the delayed statin treatment group[48.51%vs 36.09%](P<0.05). After multivariate regression analysis, hs-CRP and delayed statin treatment were still closely related to poor prognosis, after adjusting for various risk factors(P<0.05). Conclusion Early statintherapy in AIS patients may reduce the serum hs-CRP concentration in acute phaseand improve prognosisin patients withAIS.