CAJ | 학술논문

目的通过观察发病前开始阿托伐他汀钙治疗对初发脑梗死患者近期预后的影响，分析他汀类药物在脑梗死急性期的脑保护作用。方法纳入2011-2013年期间在本科连续住院120例初发脑梗死患者，发病前开始治疗组为发病前已开始服用阿托伐他汀钙的患者45例。发病后治疗组为发病24h后开始阿托伐他汀钙治疗的患者75例。登记患者高血压、糖尿病、冠心病及高脂血症史，依据影像学资料行卒中分型（采用TOAST分型）行颈动脉彩超检查并计算患者平均颈动脉内-中膜厚度（IMT），在入院时及发病3个月时行美国国立卫生院神经功能缺损评分（ NIHSS）和改良Rankin评分（ mRS评分）。以脑卒中发病后3个月时mRS≤2定义为预后良好，mRS≥3为预后较差的标准。入院时及发病3个月时行血脂分析检查。对两组患者之间的基线资料、平均颈动脉IMT、入院NIHSS、预后及TOAST分型进行对照分析，不同预后的患者进行二元Logistic回归分析发病预测因素。结果发病前开始治疗组良好预后的数量、患有高脂血症患者数量较发病后治疗组明显更多，且发病前开始治疗组有明显更低的NIHSS评分（ P＜0．05）。 Logistic回归分析提示冠状动脉性心脏病（ OR 0．13，95％CI 0．03～0．39，P＝0．006）、发病前开始阿托伐他汀钙治疗（ OR 4．8，95％CI 1．23～19．00，P＝0．025）、入院时NIHSS（ OR 1．15，95％CI 1．01～1．26，P＝0．012）是卒中后近期预后的独立预测因素。结论发病前开始服用阿托伐他汀钙可能有助于改善脑梗死患者近期预后，这种作用可能源自他汀类药物的神经保护作用。
목적통과관찰발병전개시아탁벌타정개치료대초발뇌경사환자근기예후적영향，분석타정류약물재뇌경사급성기적뇌보호작용。방법납입2011-2013년기간재본과련속주원120례초발뇌경사환자，발병전개시치료조위발병전이개시복용아탁벌타정개적환자45례。발병후치료조위발병24h후개시아탁벌타정개치료적환자75례。등기환자고혈압、당뇨병、관심병급고지혈증사，의거영상학자료행졸중분형（채용TOAST분형）행경동맥채초검사병계산환자평균경동맥내-중막후도（IMT），재입원시급발병3개월시행미국국립위생원신경공능결손평분（ NIHSS）화개량Rankin평분（ mRS평분）。이뇌졸중발병후3개월시mRS≤2정의위예후량호，mRS≥3위예후교차적표준。입원시급발병3개월시행혈지분석검사。대량조환자지간적기선자료、평균경동맥IMT、입원NIHSS、예후급TOAST분형진행대조분석，불동예후적환자진행이원Logistic회귀분석발병예측인소。결과발병전개시치료조량호예후적수량、환유고지혈증환자수량교발병후치료조명현경다，차발병전개시치료조유명현경저적NIHSS평분（ P＜0．05）。 Logistic회귀분석제시관상동맥성심장병（ OR 0．13，95％CI 0．03～0．39，P＝0．006）、발병전개시아탁벌타정개치료（ OR 4．8，95％CI 1．23～19．00，P＝0．025）、입원시NIHSS（ OR 1．15，95％CI 1．01～1．26，P＝0．012）시졸중후근기예후적독립예측인소。결론발병전개시복용아탁벌타정개가능유조우개선뇌경사환자근기예후，저충작용가능원자타정류약물적신경보호작용。
Objective To prospect investigate the impact of atorvastatin pretreatment on 3 months outcome of first-ever ischemic stroke .Methods 120 first-ever ischemic stroke cases who invited our department of neurology during 2011-2013 were enrolled , including 45 patients who were receiving atorvastatin treatment before onset of stroke (statins-pretreated group ) and 75 patients who were not ( without statins-pretreated group ).Risk factors ( hypertension , diabetes mellitus , coronary heart disease , hyperlipidemia ) for stroke of all patients were registered . The mean intima-media thickness ( m-IMT ) of carotid artery of each patient were measured respectively by color Doppler ultrasound .The neurologic functions and disabilities were evaluated by using NIHSS and mRS assessing system.Good outcome was defined as mRS≤2 at 3 months after stroke and bad outcome was defined as mRS≥3 at the same time.Regarding the image result , the TOAST stroke subclassification of every patient was determined .Lipid profile was measured at onset and 3 months after stroke.Baseline characteristics, m-IMT, NIHSS on admission, TOAST stroke subclassification and prognosis were compared between the two groups .The multivariate analysis about the predictive factors for outcome was completed with Logistic regression procedure .Results Comparing with the group without statins-pretreated , outcome was better and NIHSS scores at onset of stroke were lower in the statins -pretreated group, significantly(P<0.05).Result of the Logistic regression analysis indicated that NIHSS on admission (OR 1.15,95%CI 1.01-1.26,P=0.012), statins pretreatment(OR 4.8,95%CI 1.23-19.00,P=0.025),coronary heart disease(OR 0.13,95%CI 0.03-0.39,P=0.006)were associated with outcome of stroke.Conclusion Using of atorvastatin before ischemic stroke is associated with favorable recent outcome with reduced recent neurological disability, and neuroprotection may be the potential mechanism .