老年缺血性卒中住院患者他汀药物治疗短期预后及不良反应相关性研究

摘要/Abstract

摘要：

目的分析高龄老年缺血性卒中患者他汀药物的使用并与患者短期预后、不良反应的相关性。方法纳入年龄≥60岁急性缺血性卒中患者425例，按年龄分为高龄组（≥75岁）和老龄组（60～74岁）；记录入院期间及卒中后（90±7）d他汀类药物治疗情况，评估患者短期预后［改良Rankin量表（modified Rankin Scale，mRS）］及相关不良反应情况。对他汀药物使用与短期预后及相关不良反应进行相关性分析。结果入院期间两组他汀药物使用无明显差异；卒中后（90±7）d，高龄组他汀药物使用率较老龄组低（85.0% vs 91.6%，P=0.039），高龄组3个月预后不良率（mRS 3～5分）较老龄组比例高（57.6% vs 30.7%，P＜0.001）。Logistic多因素分析显示，无论高龄组还是老龄组，规律使用他汀类药物是卒中后3个月功能预后的保护性因素［比值比（odds ratio，OR）=0.619，P＜0.05；OR=0.498，P＜0.05］；高龄组规律他汀药物与住院期间孤立性肝酶升高相关（OR=1.789，P＜0.05）。结论高龄卒中患者出院后他汀类药物的依从性及3个月功能预后较老龄患者差；高龄和老龄卒中患者规律使用他汀类药物是短期功能预后的保护性因素；高龄患者规律使用他汀药物与孤立性肝酶升高相关。

文章导读： ≥75岁的高龄缺血性卒中患者与60岁～74岁的老龄患者相比，出院后他汀类药物使用率低；多因素分析显示高龄和老龄卒中患者规律使用他汀类药物是短期功能预后的保护性因素。

关键词: 高龄; 缺血性卒中; 他汀; 短期卒中预后; 不良反应

Abstract:

Objective To investigate statin utilization in elderly stroke patients and correlation between statin treatment and stroke outcomes of short-term. Methods A total of 425 acute ischemic stroke patients who were older than 60 years old were recruited in this study and divided into two groups by age, the very elderly (75 years old and over) and the elderly (60~74 years old). Collect data of baseline information, statin utilization, blood lipid and liver enzymes levels, short-term functional prognosis assessed by modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) and statin adverse effects during hospital and follow-up. Logistic regression was used analyzing correlation between statin utilization and short-term stroke prognosis, statin adverse effects in both groups. Results There were no significant differences in statin utilization during hospitalization between two groups. Compared with the elderly group, the very elderly group had a lower statin utilization percent (85.0% vs 91.6%, P=0.039), and a higher rate of poor prognosis (57.6% vs 30.7%, P<0.001) in follow-up. Logistic regression showed that in both groups, regular statin usage showed benefit to short term prognosis (very elderly:odds ratio [OR]=0.619, P<0.05, elderly:OR=0.498, P<0.05); In the very elderly group, regular statin usage was associated with isolated elevation of liver enzymes (OR=1.789, P<0.05). Conclusion The very elderly show poorer statin compliance after discharge and worsened prognosis in the short term compared with the elderly. Regular statin utilization shows benefit to stroke prognosis in all elderly stroke patients, and is related to isolated elevation of liver enzymes in the very elderly stroke patients.

Key words: The very elderly; Ischemic stroke; Statins; Short-term prognosis; Adverse effect

吴佳，吴硕琳，李菁晶，王琰，王春雪. 老年缺血性卒中住院患者他汀药物治疗短期预后及不良反应相关性研究[J]. 中国卒中杂志, 2015, 10(05): 391-400.

WU Jia, WU Shuo-Lin, LI Jing-Jing, WANG Yan, WANG Chun-Xue.. Study on Statin Treatment in the Very Elderly Ischemic Stroke Patients and Correlation of Statin Utilization and Short-term Prognosis of Stroke and Statin Adverse Effects [J]. Chinese Journal of Stroke, 2015, 10(05): 391-400.

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