阿托伐他汀改善蛛网膜下腔出血患者的预后分析(1)
摘 要：目的 對阿托伐他汀可降低脑损伤标记物并减少SAH后脑血管痉挛的发生率进行研究。方法 选取2015年1月～12月本院经血管造影明确诊断血管瘤破裂导致的自发性SAH且发病48 h内的患者40例，将其随机分为对照组和阿托伐他汀组，每组20例。对照组给予保护脑神经，预防脑血管痉挛等常规治疗；阿托伐他汀组在对照组常规治疗的基础上给予阿托伐他汀，每周记录谷丙转氨酶，谷草转氨酶以及肌酸激酶评估肝损伤及肌损伤。每天记录脑损伤标记物变化情况。记录血管造影或经颅多普勒测量大脑中动脉血流峰值超过160 m/sec为发生血管痉挛的指标。结果 阿托伐他汀组与对照组肝损伤及肌损伤发生率比较，差异无统计学意义(P>0.05)。阿托伐他汀组血清中vWF因子平均浓度11.95 ng/ml，低于对照组21.59 ng/ml，差异有统计学意义(P<0.05)；阿托伐他汀组血清中S100β因子平均浓度50.8 pg/ml，低于对照组190.5 pg/ml，统计学意义显著(P<0.01)。经颅多普勒大脑中动脉血流峰值阿托伐他汀组(103.11±41.01)m/sec，低于对照组(149.12±48.12)m/sec，统计学意义显著(P<0.01)。阿托伐他汀组血管痉挛发生率 25.00%，低于对照组60.00%，差异有统计学意义(P<0.05)。结论 自发性蛛网膜下腔出血患者及早使用阿托伐他汀可明显较少血管痉挛的发生率，并具有良好的安全性及耐受性。阿托伐他汀可降低血清中SHA脑损伤标记物，减少血管痉挛，减轻迟发型缺血性损伤，改善SAH患者预后。
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关键词：阿托伐他汀；蛛网膜下腔出血；血管痉挛
中图分类号：R743.35 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.14.043
文章编号：1006-1959(2018)14-0142-03
Abstract：Objective To investigate the effect of atorvastatin on reducing the markers of brain injury and reducing the incidence of cerebral vasospasm after SAH.Methods A total of 40 patients with spontaneous SAH and within 48 h onset were diagnosed by angiography in January to December 2015.They were randomly divided into control group and atorvastatin group with 20 cases in each group.The control group was given routine treatment such as protecting the brain nerve and preventing cerebral vasospasm，while the atorvastatin group was given atorvastatin on the basis of the routine treatment in the control group，liver damage and muscle damage were assessed weekly by recording alanine aminotransferase，aspartate aminotransferase，and creatine kinase.Changes in brain damage markers were recorded daily.Recording angiography or transcranial Doppler measurements of peak blood flow in the middle cerebral artery over 160 m/sec is an indicator of vasospasm.Results There was no significant difference in the incidence of liver injury and muscle injury between atorvastatin and control group(P>0.05).The average serum concentration of vWF in atorvastatin group was 11.95 ng/ml，which was significantly lower than that in control group 21.59 ng/ml，the difference was statistically significant (P<0.05)，the average concentration of S100β in the serum of atorvastatin group was 50.8 pg/ml，which was lower than that of the control group 190.5 pg/ml，which was statistically significant(P<0.01).Transcranial Doppler middle cerebral artery blood flow peak atorvastatin group(103.11±41.01)m/sec，lower than the control group(149.12±48.12)m/sec，statistically significant(P<0.01).The incidence of vasospasm in the atorvastatin group was 25.00%，which was lower than that in the control group 60.00%，and the difference was statistically significant(P<0.05).Conclusion Early use of atorvastatin in patients with spontaneous subarachnoid hemorrhage can significantly reduce the incidence of vasospasm and has good safety and tolerance.Atorvastatin can reduce serum SHA brain damage markers， reduce vasospasm， reduce delayed ischemic injury， and improve the prognosis of SAH patients., 百拇医药(王润俊)
, http://www.100md.com
关键词：阿托伐他汀；蛛网膜下腔出血；血管痉挛
中图分类号：R743.35 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.14.043
文章编号：1006-1959(2018)14-0142-03
Abstract：Objective To investigate the effect of atorvastatin on reducing the markers of brain injury and reducing the incidence of cerebral vasospasm after SAH.Methods A total of 40 patients with spontaneous SAH and within 48 h onset were diagnosed by angiography in January to December 2015.They were randomly divided into control group and atorvastatin group with 20 cases in each group.The control group was given routine treatment such as protecting the brain nerve and preventing cerebral vasospasm，while the atorvastatin group was given atorvastatin on the basis of the routine treatment in the control group，liver damage and muscle damage were assessed weekly by recording alanine aminotransferase，aspartate aminotransferase，and creatine kinase.Changes in brain damage markers were recorded daily.Recording angiography or transcranial Doppler measurements of peak blood flow in the middle cerebral artery over 160 m/sec is an indicator of vasospasm.Results There was no significant difference in the incidence of liver injury and muscle injury between atorvastatin and control group(P>0.05).The average serum concentration of vWF in atorvastatin group was 11.95 ng/ml，which was significantly lower than that in control group 21.59 ng/ml，the difference was statistically significant (P<0.05)，the average concentration of S100β in the serum of atorvastatin group was 50.8 pg/ml，which was lower than that of the control group 190.5 pg/ml，which was statistically significant(P<0.01).Transcranial Doppler middle cerebral artery blood flow peak atorvastatin group(103.11±41.01)m/sec，lower than the control group(149.12±48.12)m/sec，statistically significant(P<0.01).The incidence of vasospasm in the atorvastatin group was 25.00%，which was lower than that in the control group 60.00%，and the difference was statistically significant(P<0.05).Conclusion Early use of atorvastatin in patients with spontaneous subarachnoid hemorrhage can significantly reduce the incidence of vasospasm and has good safety and tolerance.Atorvastatin can reduce serum SHA brain damage markers， reduce vasospasm， reduce delayed ischemic injury， and improve the prognosis of SAH patients., 百拇医药(王润俊)