急性脑梗死患者静脉溶栓前进行阿托伐他汀预处理的疗效及安全性分析

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摘要目的观察急性脑梗死患者静脉溶栓前进行阿托伐他汀预处理的临床疗效及不良反应，以评价他汀药物预处理能否让静脉溶栓患者得到更好的临床获益。方法选择2013年1月～2016年2月在广西医科大学第四附属医院神经内科住院的急性脑梗死患者100例，按照随机数字表法随机分为两组，研究组（50例）：阿托伐他汀预处理联合rt-PA静脉溶栓组，对照组（50例）：rt-PA静脉溶栓组。研究组患者在静脉溶栓前先给予阿托伐他汀（40 mg，qd）口服或鼻饲进行预处理；对照组患者在静脉溶栓后1周才开始给予阿托伐他汀（40 mg，qd）口服或鼻饲。两组患者均按《中国急性缺血性脑卒中诊治指南2014》推荐意见进行rt-PA静脉溶栓。观察两组患者7 d神经功能改善和恶化、90 d良好功能转归、症状性颅内出血以及死亡分别所占的比例，以评估他汀预处理在脑梗死静脉溶栓中的有效性及安全性。结果研究组7 d神经功能改善率为56%，对照组率为36%，两组比较差异有统计学意义（P < 0.05）。研究组90 d良好功能转归率为38%，对照组率为24%，两组比较差异无统计学意义（P > 0.05）。研究组7 d神经功能恶化率为16%，对照组率为34%，两组比较差异有统计学意义（P < 0.05）。研究组症状性颅内出血率为6%，对照组率为4%，两组比较差异无统计学意义（P > 0.05）。研究组3个月死亡率为4%，对照组率为2%，两组比较差异无统计学意义（P > 0.05）。结论急性脑梗死患者静脉溶栓前进行阿托伐他汀预处理可提高短期疗效。中等剂量他汀预处理不增加静脉溶栓患者症状性颅内出血及死亡的发生率。

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	邓珊潘丽雅阳洪林宝全寻卫权卢先富彭日红

关键词 ：急性脑梗死, 他汀预处理, 静脉溶栓, 疗效分析

Abstract：Objective To observe the clinical efficacy and adverse reactions of Atorvastatin pretreatment before intravenous thrombolysis in patients with acute cerebral infarction. Methods From January 2013 to February 2016, in the Department of Neurology, Fourth Affiliated Hospital of Guangxi Medical University, 100 patients with primary acute cerebral infarction were collected, they were divided into two groups by random number table, study group (n = 50) and control group (n = 50). Patients in study group were given Atorvastatin (40 mg, qd) oral or nasal feeding before intravenous thrombolysis. Patients in control group were given Atorvastatin (40 mg, qd) after 7 d intravenous thrombolysis treatment. All patients were given rt-PA intravenous thrombolysis according to Recommendations of China Acute Ischemic Stroke Diagnosis and Treatment Guide 2014. The rate of 7 d neurological function improvement, 7 d neurological deterioration, 90 d good functional recovery, symptomatic intracranial hemorrhageand mortality in the two groups were observed. Results The rate of 7 d neurologic improvement in study group was 56%, that in the control group was 36%, two groups were compared, the differences were statistically significant (P < 0.05). The rate of 90 d good functional recovery in study group was 38%, that in control group was 24%, two groups were compared, the differences were statistically significant (P < 0.05). The rate of 7 d neurologic deterioration was 16%, that in control group was 34%, two groups were compared, the differences were statistically significant (P < 0.05). In study group, the rate of symptomatic intracerebral hemorrhage and 3-month mortality were 6% and 4%, those in the control group were 4% and 2%, two groups were compared, the differences were not statistically significant (P > 0.05). Conclusion Atorvastatin pretreatment before intravenous thrombolysis in patients with acute cerebral infarction could improve the short-term efficacy. Moderate dose of statin pretreatmentdoes not increase the incidence of symptomatic intracranial hemorrhage and mortality in patients undergoing intravenous thrombolysis.

Key words： Acute cerebral infarction Statin pretreatment Intravenous thrombolysis Curative effect analysis

基金资助:广西壮族自治区卫计委计划课题（z2015144）。

通讯作者: 阳洪（1966-），男，硕士，主任医师；研究方向：脑血管病。

作者简介: 邓珊（1980-），女，硕士；研究方向：脑血管病。

引用本文:

邓珊潘丽雅阳洪林宝全寻卫权卢先富彭日红. 急性脑梗死患者静脉溶栓前进行阿托伐他汀预处理的疗效及安全性分析[J]. 中国医药导报, 2017, 14(19): 55-58.
DENG Shan PAN Liya YANG Hong LIN Baoquan XUN Weiquan LU Xianfu PENG Rihong. Efficacy and safety of Atorvastatin in patients with acute cerebral infarction before intravenous thrombolysis. 中国医药导报, 2017, 14(19): 55-58.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I19/55

[1] Xu AD，Wang YJ，Wang DZ，et al. Consensus statement on the use of intravenous recombinant tissue plasminogen activator to treat acute ischemic stroke by the Chinese Stroke Therapy Expert Panel [J]. CNS Neurosci Ther，2013，19（8）：543-548.
[2] Jauch EC，Saver JL，Adams HP，et al. Guidelines for the early management of patients with acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke，2013，44（3）：870-947.
[3] Levy EI，Siddiqui AH，Crumlish A，et al. First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke：SARIS （stent-assisted recanalization in acute ischemic stroke）[J]. Stroke，2009，40（11）：3552-3556.
[4] Emberson J，Lees KR，Lyden P，et al. Effect of treatment delay，age，and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke：a meta-analysis of individual patient data from randomised trials [J]. Lancet，2014，384（9958）：1929-1935.
[5] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志，2015，48（4）：246-267.
[6] Kharitonova T，Mikulik R，Roine RO，et al. Safe Implementation of Thrombolysis in Stroke Investigators. Association of early National Institutes of Health Stroke Scale improvement with vessel recanalization and functional outcome after intravenous thrombolysis in ischemic stroke [J]. Stroke，2011，42（6）：1638-1643.
[7] Wahlgren N，Ahmed N，Dávalos A，et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study （SITS-MOST）：an observational study [J]. Lancet，2007，369（9558）：275-282.
[8] Delgado MG，Michel P，Naves M，et al. Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population [J]. J Neurol Neurosurg Psychiatry，2010，81（3）：282-285.
[9] Adams HP Jr，Bendixen BH，Kappelle LJ，et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment [J]. Stroke，1993，24（1）：35-41.
[10] Amin-Hanjani S，Stagliano NE，Yamada M，et al.Mevastatin，an HMG-CoA reductase inhibitor，reduces stroke damage and upregulates endothelial nitric oxide synthase in mice [J]. Stroke，2001，32（4）：980-986.
[11] Cappellari M，Deluca C，Tinazzi M，et al. Does statin in the acute phase of ischemic stroke improve outcome after intravenous thrombolysis? A retrospective study [J]. J Neurol Sci，2011，308（1-2）：128-134.
[12] Zhang L，Zhang ZG，Ding GL，et al. Multitargeted effects of statin-enhanced thrombolytic therapy for stroke with recombinant human tissue-type plasminogen activator in the rat [J]. Circulation，2005，112（22）：3486-3494.
[13] Keyt BA，Paoni NF，Refino CJ，et al. A fasteracting and more potent form of tissue plasminogen activator[J]. Proc Natl Acad Sci USA，1994，91（9）：3670-3674.
[14] Laufs U，Gertz K，Huang P，et al. Atorvastatin upregulates type Ⅲ nitric oxide synthase in thrombocytes，decreases platelet activation，and protects from cerebral ischemia in normocholesterolemic mice [J]. Stroke，2000， 31（10）：2442-2449.
[15] Van der Most PJ，Dolga AM，Nijholt IM，et al. Statins： mechanisms of neuroprotection [J]. Prog Neurobiol，2009，88（1）：64-75.
[16] Wang S，Lee SR，Guo SZ，et al. Reduction of tissue plasminogen activator-induced matrix metalloproteinase-9 by simvastatin in astrocytes [J]. Stroke，2006，37（7）：1910-1912.
[17] Cappellari M，Bovi P，Moretto G，et al. The THRombolysis and STatins （THRaST） study [J]. Neurology，2013，80（7）：655-661.
[18] Scheitz JF，Seiffge DJ，Tütüncü S，et al. Dose-related effects of statins on symptomatic intracerebral hemorrhage and outcome after thrombolysis for ischemic stroke [J]. Stroke，2014，45（2）：509-514.
[19] Saqqur M，Uchino K，Demchuk AM，et al. Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke [J]. Stroke，2007，38（3）：948-954.
[20] Bhatia R，Hil MD，Shobha N，et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke： real-world experience and a call for action [J]. Stroke，2010，41（10）：2254-2258.