Neurology：卒中前使用他汀类药物减轻缺血性卒中的临床症状

最新指南显示，卒中后使用他汀类药物有利于卒中患者的预后，但是卒中前使用他汀类药物对预后的情况尚不明确。来自西班牙Patricia Martínez-Sánchez等医生回顾性分析了卒中前使用他汀的患者预后情况，结果发表在2013年5月7日Neurology杂志上。该研究检测在临床实践中，发生缺血性卒中前已服用高剂量他汀类药物（40mg瑞舒伐他汀或80mg其他类型他汀类药物）和中低剂量他汀类药物（小于40mg瑞舒伐他汀或小于80mg其他类型他汀药物）对卒中严重程度的影响。研究结果显示：卒中前使用他汀类药物减轻缺血性卒中的严重程度。

观察2008年至2010年3年期间卒中单元的缺血性卒中患者。轻度卒中定义为入院时NIHSS评分小于或等于5分。多因素回归模型及配对倾向指数分析用于确定卒中前服用高剂量或中低剂量他汀类药物与轻度卒中的相关性。

在969例缺血性卒中患者中，23%的患者发生卒中之前服用中低剂量他汀类药物，4.1%的患者服用高剂量他汀。服用他汀类药物的患者入院时NIHSS评分较低（未服用他汀组平均评分为4分，四分位距为9分，中低剂量组平均分为4分，四分位距为9分，高剂量组为2分，四分位距为4分；p = 0.010）。调整不同因素后，非匹配分析显示，发生卒中前服用他汀类药物卒中的临床症状较轻（中低剂量组优势比[OR] = 1.637，95% 可信区间[CI]为1.156–2.319，高剂量组OR = 3.297, 95%可信区间CI为1.480–7.345），配对的倾向指数分析仍然显示此结果（中低剂量他汀类药物组OR = 2.023, 95%可信区间CI为1.248–3.281，高剂量组OR = 3.502, 95%可信区间CI为1.477–8.300）。

本研究显示，发生卒中前使用高剂量或中低剂量他汀类药物的患者卒中的严重程度较轻。
与他汀类相关的拓展阅读：

• AACR2013：他汀类药物可显著降低乳腺癌死亡率
• MedPage：加拿大新指南称糖尿病患者40岁时应该使用他汀类药物
• JCO：他汀类药物可降低丙肝人群的肝细胞癌发病风险
• Am J Cardiol:他汀类治疗可降低CABG术后急性肾损伤风险
• Lancet：好的身体素质可以增强他汀类药物的疗效
• SABCS：他汀类药物或可改善炎性乳腺癌PFS
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Sofosbuvir for Previously Untreated Chronic Hepatitis C Infection.
Background
In phase 2 trials, the nucleotide polymerase inhibitor sofosbuvir was effective in previously untreated patients with chronic hepatitis C virus (HCV) genotype 1, 2, or 3 infection.
Methods
We conducted two phase 3 studies in previously untreated patients with HCV infection. In a single-group, open-label study, we administered a 12-week regimen of sofosbuvir plus peginterferon alfa-2a and ribavirin in 327 patients with HCV genotype 1, 4, 5, or 6 (of whom 98% had genotype 1 or 4). In a noninferiority trial, 499 patients with HCV genotype 2 or 3 infection were randomly assigned to receive sofosbuvir plus ribavirin for 12 weeks or peginterferon alfa-2a plus ribavirin for 24 weeks. In the two studies, the primary end point was a sustained virologic response at 12 weeks after the end of therapy.
Results
In the single-group study, a sustained virologic response was reported in 90% of patients (95% confidence interval, 87 to 93). In the noninferiority trial, a sustained response was reported in 67% of patients in both the sofosbuvir-ribavirin group and the peginterferon-ribavirin group. Response rates in the sofosbuvir-ribavirin group were lower among patients with genotype 3 infection than among those with genotype 2 infection (56% vs. 97%). Adverse events (including fatigue, headache, nausea, and neutropenia) were less common with sofosbuvir than with peginterferon.
Conclusions
In a single-group study of sofosbuvir combined with peginterferon-ribavirin, patients with predominantly genotype 1 or 4 HCV infection had a rate of sustained virologic response of 90% at 12 weeks. In a noninferiority trial, patients with genotype 2 or 3 infection who received either sofosbuvir or peginterferon with ribavirin had nearly identical rates of response (67%). Adverse events were less frequent with sofosbuvir than with peginterferon. (Funded by Gilead Sciences; FISSION and NEUTRINO ClinicalTrials.gov numbers, NCT01497366 and NCT01641640 , respectively.).