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Stroke：脑出血患者是否应该服用他汀类药物？

2015-06-16 大鹏 cmt

脑出血他汀
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有关ICH患者使用他汀类药物一直存在争议。近期，美国心脏学会和美国卒中学会(AHA/ASA)于《卒中》(Stroke)杂志发布了新版脑出血(ICH)管理指南，或许该指南相关内容能初步解答上述问题。在预防ICH复发方面，指南推荐，尚缺乏足够证据限制ICH患者服用他汀类药物(Ⅱb，C)。以下为该指南制定此项指导意见的相关证据。        SPARC

有关ICH患者使用他汀类药物一直存在争议。近期，美国心脏学会和美国卒中学会(AHA/ASA)于《卒中》(Stroke)杂志发布了新版脑出血(ICH)管理指南，或许该指南相关内容能初步解答上述问题。在预防ICH复发方面，指南推荐，尚缺乏足够证据限制ICH患者服用他汀类药物(Ⅱb，C)。以下为该指南制定此项指导意见的相关证据。
        
SPARCL研究显示，大剂量阿托伐他汀可以降低缺血型卒中的复发，但这种治疗收益的一部分会被升高的ICH风险所抵消。二次分析结果显示，他汀治疗、老龄及ICH疾病本身均是后期出现ICH的相关风险因素。
        
另一方面，一项涉及31项临床试验共纳入91588例接受他汀治疗患者的meta分析结果显示，ICH与他汀治疗之间无显著相关性(OR值为1.08，P=0.47)，而且他汀治疗显著降低了所有卒中发生率及全因死亡率。
        
另有研究者采用马克夫(Markov)分析法分析了既往ICH患者接受他汀治疗的利弊，其结论为，如果他汀确实升高了ICH风险，可以考虑避免他汀治疗，这点对于脑叶出血患者尤其重要。与这些研究相似的结论是，他汀治疗及患者年龄与ICH患者微出血病灶的出现及其数量(尤其是患者大脑皮质部)独立相关。
        
与上述结论相反，小型回顾性研究显示，ICH患者继续用他汀治疗与其早期神经系统改善及6个月死亡率降低有关。另外，目前尚无数据证实他汀治疗出现的ICH倾向性是否是呈剂量依赖性。
        
综上所述，有关ICH患者是否接受他汀治疗尚有争议，因此，新指南专家组延续了原指南内容。

原始出处：

J. Claude Hemphill III, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage.Stroke. Published online before print May 28, 2015,doi:10.1161/STR.0000000000000069

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2044373, encodeId=665120443e374, content=<a href='/topic/show?id=644725344b1' target=_blank style='color:#2F92EE;'>#他汀类药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25344, encryptionId=644725344b1, topicName=他汀类药)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Sat Sep 05 17:30:00 CST 2015, time=2015-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30869, encodeId=d6463086942, content=ICH患者应该还是要服用他汀类药物, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=51b9105133, createdName=qing1231990, createdTime=Sun Jul 05 17:03:00 CST 2015, time=2015-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29883, encodeId=f50129883e2, content=需要好好研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Jun 29 18:08:00 CST 2015, time=2015-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29298, encodeId=b3342929806, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Thu Jun 25 23:23:00 CST 2015, time=2015-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27801, encodeId=bc9e2e80103, content=观, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=121e1622385, createdName=chenhui888, createdTime=Tue Jun 16 15:16:00 CST 2015, time=2015-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27784, encodeId=dcf52e78440, content=需要看看原文和入选的试验, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Tue Jun 16 12:35:00 CST 2015, time=2015-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27774, encodeId=53972e77470, content=复杂, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=efcb1614039, createdName=qinweihan19, createdTime=Tue Jun 16 12:08:00 CST 2015, time=2015-06-16, status=1, ipAttribution=)]
    2015-09-05 ms6390871039024434

    #他汀类药#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2044373, encodeId=665120443e374, content=<a href='/topic/show?id=644725344b1' target=_blank style='color:#2F92EE;'>#他汀类药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25344, encryptionId=644725344b1, topicName=他汀类药)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Sat Sep 05 17:30:00 CST 2015, time=2015-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30869, encodeId=d6463086942, content=ICH患者应该还是要服用他汀类药物, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=51b9105133, createdName=qing1231990, createdTime=Sun Jul 05 17:03:00 CST 2015, time=2015-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29883, encodeId=f50129883e2, content=需要好好研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Jun 29 18:08:00 CST 2015, time=2015-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29298, encodeId=b3342929806, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Thu Jun 25 23:23:00 CST 2015, time=2015-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27801, encodeId=bc9e2e80103, content=观, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=121e1622385, createdName=chenhui888, createdTime=Tue Jun 16 15:16:00 CST 2015, time=2015-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27784, encodeId=dcf52e78440, content=需要看看原文和入选的试验, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Tue Jun 16 12:35:00 CST 2015, time=2015-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=27774, encodeId=53972e77470, content=复杂, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=efcb1614039, createdName=qinweihan19, createdTime=Tue Jun 16 12:08:00 CST 2015, time=2015-06-16, status=1, ipAttribution=)]
    2015-07-05 qing1231990

    ICH患者应该还是要服用他汀类药物

    0

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    2015-06-29 owlhealth

    需要好好研究

    0

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    2015-06-25 huaxipanxing

    看看

    0

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    2015-06-16 chenhui888

    观

    0

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    2015-06-16 owlhealth

    需要看看原文和入选的试验

    0

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    2015-06-16 qinweihan19

    复杂

    0

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