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目的研究发病前他汀类药物使用对急性缺血性脑卒中静脉溶栓患者的疗效与安全性的影响。方法回顾性分析脑梗死溶栓患者187例,预后评价标准:短期有效(脑卒中时与1周NIHSS评分差值≥4或8分)、长期有效(3个月m RS评分≤2或1分)、颅内出血、症状性颅内出血及死亡。筛选Pubmed和Embase中包含以上评价标准的文献,用Review Manager 5.2.6进行荟萃分析。结果单因素分析中,脑卒中前服用他汀类药物在短期有效,差异有统计学意义(OR=2.01,95%CI:1.06~3.90,P=0.030)。多因素分析中,脑卒中前服用他汀类药物与各项预后评价指标无关。荟萃分析中,脑卒中前服用他汀类药物与症状性颅内出血(OR=1.49,95%CI:1.16~1.90,P=0.001)相关,与长期预后良好、死亡无关。结论缺血性脑卒中溶栓患者发病前他汀类药物使用与预后关系不大,脑卒中前他汀类药物服用与静脉溶栓的联合治疗可能是安全的。
Objective To study the effect of pre-morbid statins on the efficacy and safety of intravenous thrombolysis in patients with acute ischemic stroke. Methods A total of 187 patients with thrombolysis in cerebral infarction were retrospectively analyzed. The prognostic criteria were short-term efficacy (NIHSS score ≥4 or 8 at stroke and one week), long-term efficacy (3 months mRS score ≤2 or 1 ), Intracranial hemorrhage, symptomatic intracranial hemorrhage and death. Screened Pubmed and Embase documents containing the above criteria for evaluation, and a meta-analysis using Review Manager 5.2.6. Results In the univariate analysis, statins before stroke were effective in the short term, with significant difference (OR = 2.01, 95% CI: 1.06-3.90, P = 0.030). In multivariate analysis, the use of statins before stroke was not associated with any of the prognostic indicators. In the meta-analysis, pre-stroke statin use was associated with symptomatic intracranial hemorrhage (OR = 1.49, 95% CI: 1.16-1.90, P = 0.001) and was unrelated to long-term prognosis and death. Conclusions The use of statins before onset of ischemic stroke is not related to the prognosis of ischemic stroke patients. Combination therapy of statins and intravenous thrombolysis before stroke may be safe.