CNS Drugs:降低缺血性卒中后癫痫风险 就靠这种神药

2018-05-04 易湛苗 环球医学网

卒中是成人癫痫的重要病因之一,约有55%的成人癫痫由卒中引起。卒中后癫痫(PSE)引发的残疾和死亡带来巨大的社会和医疗负担。很多抗癫痫药物(AEDs)都可以有效治疗PSE。但令人失望的是,由于AEDs众所周知的不良反应和相互作用,目前专业指南不推荐常规使用AEDs用于PSE预防。对此,具有神经保护作用的他汀带来希望。

卒中是成人癫痫的重要病因之一,约有55%的成人癫痫由卒中引起。卒中后癫痫(PSE)引发的残疾和死亡带来巨大的社会和医疗负担。很多抗癫痫药物(AEDs)都可以有效治疗PSE。但令人失望的是,由于AEDs众所周知的不良反应和相互作用,目前专业指南不推荐常规使用AEDs用于PSE预防。对此,具有神经保护作用的他汀带来希望。

2018年发表在《CNS Drugs》的一项由台湾科学家进行的研究,基于台湾人群健康保险数据,考察了他汀强度对缺血性PSE风险的影响,以获得更多支持其用于PSE预防的真实世界证据。

通过研究台湾健康保险(2003~2013)数据库,考察了他汀使用与进展为PSE风险之间的相关性,包括处方时机(卒中前vs卒中后)、他汀类型(亲脂性、治疗强度)和剂量强度等。

确定新发缺血性卒中的患者。主要结局为确诊缺血性卒中后癫痫。根据卒中前他汀的使用情况,采用ANOVA比较当前使用者和非使用者。扩展Cox回归模型用于评估PSE的风险比(HR),卒中后他汀使用和某些联合用药作为时间依赖变量。序贯敏感性分析用于保证研究的稳健性。

研究确定20858例缺血性卒中患者中,954例(4.6%)发生PSE。卒中后他汀使用而非卒中前他汀使用与PSE风险显着降低相关。PSE风险降低与他汀累积限定日剂量(cDDD)四分位数之间具有剂量效应关系。还对PSE的风险预测因素和PSE预防因素进行了描述。

作者认为,缺血性卒中后,他汀使用以cDDD依赖的形式与PSE风险降低相关。需要进一步的临床研究来调查他汀预防PSE的潜在应用情况,尤其对于高风险的患者。

本研究通过分析全岛健康保险(2003~2013)数据,使用他汀处方、cDDDs和合并用药作为时依协变量,显示了卒中后他汀使用与PSE风险降低之间强有力的相关性。较高的卒中后他汀累积剂量与较低的PSE危害相关。

本研究还确定了一些可预测PSE合并症或预防PSE的联合用药。

因此,在卒中之后,阻止卒中后癫痫的发生,他汀或带来意想不到的惊喜。

原始出处:
Lin FJ, Lin HW, Ho YF.Effect of Statin Intensity on the Risk of Epilepsy After Ischaemic Stroke: Real-World Evidence from Population-Based Health Claims.CNS Drugs. 2018 Apr 4. doi: 10.1007/s40263-018-0501-0. [Epub ahead of print]

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1862309, encodeId=128c1862309c1, content=<a href='/topic/show?id=1f0e626267' target=_blank style='color:#2F92EE;'>#Drug#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6262, encryptionId=1f0e626267, topicName=Drug)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=baf586, createdName=wangbingxhy, createdTime=Sat Feb 16 09:22:00 CST 2019, time=2019-02-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1914243, encodeId=0925191424393, content=<a href='/topic/show?id=4b8349356f' target=_blank style='color:#2F92EE;'>#CNS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4935, encryptionId=4b8349356f, topicName=CNS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c737344, createdName=lg.zhao, createdTime=Thu Dec 06 02:22:00 CST 2018, time=2018-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1671337, encodeId=7d0016e13374d, content=<a href='/topic/show?id=9f4e360191a' target=_blank style='color:#2F92EE;'>#卒中后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36019, encryptionId=9f4e360191a, topicName=卒中后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff7426824786, createdName=waiwai3039, createdTime=Tue Nov 20 05:22:00 CST 2018, time=2018-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806244, encodeId=5531180624414, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Fri Feb 22 13:22:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893050, encodeId=fb2c189305026, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Fri Dec 07 00:22:00 CST 2018, time=2018-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1784761, encodeId=f63b1e8476103, content=<a href='/topic/show?id=e451626993' target=_blank style='color:#2F92EE;'>#drugs#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6269, encryptionId=e451626993, topicName=drugs)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dcaa509, createdName=tsing_hit, createdTime=Sat Jun 30 12:22:00 CST 2018, time=2018-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026034, encodeId=68161026034de, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri May 04 12:22:00 CST 2018, time=2018-05-04, status=1, ipAttribution=)]
    2019-02-16 wangbingxhy
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    2018-12-06 lg.zhao
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    2018-06-30 tsing_hit
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    2018-05-04 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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