Zhongguo cuzhong zazhi (Jun 2018)
住院期间他汀类药物治疗对伴有慢性肾脏病的急性缺血性卒中患者短期卒中复发的影响 Effect of Statin Use During Hospitalization on Short-term Stroke Recurrence in Acute Ischemic Stroke with Chronic Kidney Disease in Chinese Population
Abstract
目的 分析住院期间使用他汀类药物降低伴有慢性肾病（chronic kidney disease，CKD）的急性缺血性 卒中患者短期复发的效果。 方法 选取中国国家卒中登记研究（China National Stroke Registry，CNSR）中首次发病，且发病前 未服用他汀类药物治疗的缺血性卒中患者作为研究对象。根据肾小球滤过率（estimated glomerular filtration rate，eGFR）将患者分成三组，肾功能正常组[eGFR≥90 ml/（min·1.73 m2）]、轻度CKD组[60 ml/ （mi n·1.73 m2）≤eGFR＜90 ml/（mi n·1.73 m2）]和中度CKD组[eGFR＜60 ml/（min·1.73 m2）]。采用多因素 Logistic回归分析，分析住院期间他汀类药物治疗与不同肾脏功能缺血性卒中患者3个月卒中复发的相 关性。 结果 在5951例患者中，2595例（43.6%）患者卒中后住院期间使用他汀类药物，与未使用他汀类药 物治疗组相比，住院期间使用他汀类药物可以降低伴有CKD的缺血性卒中患者的3个月卒中复发风 险，包括轻度CKD组[比值比（odds ratios，OR）0.69，95%可信区间（confidence interval，CI）0.50～0.95， P =0.02]和中度CKD组（OR 0.48，95%CI 0.28～0.83，P =0.009）。然而在肾功能正常组，他汀类药物治 疗无明显疗效（OR 0.80，95%CI 0.60～1.06，P =0.12）。 结论 在中国人群中，住院期间使用他汀类药物可降低伴有轻度CKD和中度CKD的缺血性卒中患者3 个月卒中复发风险，但不能降低正常肾脏功能缺血性卒中患者卒中复发风险，该结论应在更大样本 人群中进一步验证。 Abstract: Objective We investigated the effect of statin use during hospitalization in reducing short-term stroke recurrence of patients with acute ischemic stroke and chronic kidney diseases (CKD). Methods Data of first-ever ischemic stroke patients without a history of pre-stroke statin use was derived from the China National Stroke Registry (CNSR). Patients were stratified according to estimated glomerular filtration rate (eGFR): normal renal function [eGFR≥90 ml/(min·1.73 m2)], mild CKD [60 ml/(min·1.73 m2)≤eGFR<90 ml/(min·1.73 m2)] and moderate CKD [eGFR<60 ml/(min·1.73 m2)]. Multi-factors logistic regression analysis was used to evaluate the association between statin use during hospitalization and stroke recurrence with different renal functions at 3-month follow-up. Results Among 5951 patients included, 2595 (43.6%) patients were on statin use during hospitalization after stroke. Compared with non-statin group, statin use during hospitalization was associated with decreased stroke recurrence in patients with mild CKD [odds ratios (OR) 0.69, 95% confidence interval (CI) 0.50-0.95, P =0.02] and moderate CKD (OR 0.48, 95%CI 0.28-0.83, P =0.009) at 3-month follow-up, respectively. Whereas in patients with normal renal function, no significant benefit from statin therapy was detected (OR 0.80, 95%CI 0.60-1.06, P =0.12). Conclusion Statin use during hospitalization was associated with decreased stroke recurrence in ischemic stroke patients with mild and moderate CKD at 3-month follow-up, but not in patients with normal renal function in Chinese population. Further studies are needed to confirm this finding.
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