Stroke：卒中前他汀的使用情况与脑出血预后无关

血脂水平和发病前他汀使用情况与脑出血预后的关系尚不清楚。为此，芬兰赫尔辛基大学赫尔辛基总医院神经科的Satu Mustanoja博士等人进行了一项研究，研究结果在线发表在2013年6月11日的Stroke杂志上，研究结果显示：发病前他汀使用对脑出血的转归没有影响，但是低密度脂蛋白较低与较高的住院死亡率相关。

赫尔辛基脑出血研究是一个对连续性脑出血患者进行的单中心观察性注册。注册中纳入964位脑出血患者。他汀类药物使用者有187位（占19%）。研究发病前他汀应用、基线血脂水平及临床转归的相关性。

研究结果显示：相较那些没有使用他汀类药物的患者，他们年龄较大，合并症较多，同时服用其他药物的比例更高、血脂较低、入院时的Glasgow 昏迷量表得分更高。使用和没有使用他汀类药物的患者出院时的改良Rankin评分没有差异。在发病3个月或12个月时，相较存活的患者，住院期间死亡患者的总胆固醇和低密度脂蛋白胆固醇水平较低 (两者分别为：中位4.1mmol/L [四分位范围3.6–4.4]对比4.5 [3.8–5.1]; P<0.01; 1.9mmol/L [1.4–2.5] 对比 2.4[1.8–3.0]; P<0.001)。在校正了已知的脑出血预后因素（基于单变量分析为：年龄、NIHSS评分、Glasgow昏迷量表、脑出血量及脑室内部位）后，低密度脂蛋白水平与住院死亡率独立相关(优势比：0.54 [95%可信区间： 0.31–0.93]; P=0.028)。

该研究发现：发病前他汀使用对脑出血的转归没有影响，但是低密度脂蛋白较低与较高的住院死亡率相关。

Association of Prestroke Statin Use and Lipid Levels With Outcome of Intracerebral Hemorrhage.
BACKGROUND AND PURPOSE
It is unclear whether blood lipid profiles and statin use before intracerebral hemorrhage (ICH) are associated with its outcome.
METHODS
The Helsinki ICH Study, a single-center observational registry of consecutive ICH patients, was used to study the associations between premorbid statin use, baseline lipid levels, and clinical outcome.
RESULTS
The registry includes 964 ICH patients. Statin users (n=187; 19%) were significantly older, had more frequent comorbidities and medication, lower lipid levels, and higher admission Glasgow Coma Scale compared with nonusers. Modified Rankin Scale at discharge or mortality did not differ between statin users and nonusers. Compared with survivors, significantly lower total cholesterol and low-density lipoprotein cholesterol levels were observed in patients who died in hospital (median, 4.1 mmol/L [interquartile range, 3.6-4.4] versus 4.5 [3.8-5.1]; P<0.01; 1.9 mmol/L [1.4-2.5] versus 2.4 [1.8-3.0]; P<0.001, respectively), at 3 or 12 months. After adjusting for known ICH prognostic factors based on univariate analysis that is, age, National Institutes of Health Stroke Scale, Glasgow Coma Scale, ICH volume, and intraventricular location, lower low-density lipoprotein levels were independently associated with in-hospital mortality (odds ratio, 0.54 [95% confidence interval, 0.31-0.93]; P=0.028).
CONCLUSIONS
Premorbid statin use did not affect the outcome of ICH, but lower low-density lipoprotein levels were associated with higher in-hospital mortality.