调脂方案与急性非心源性脑梗死合并脑微出血患者预后的关系

The Relationship between Lipid-Lowering Therapy and Prognosis of Patients with Acute Non-Cardiogenic Cerebral Infarction Combined with Cerebral Microbleeds

摘要: 目的：探讨调脂方案对急性非心源性脑梗死合并脑微出血患者临床结局的影响。方法：连续回顾性纳入2016年1月1日~2021年2月28日在青岛大学附属医院住院的应用调脂药物的急性非心源性脑梗死合并脑微出血患者。根据调脂药物方案将患者分为常规降脂方案组及强化降脂方案组。对患者进行电话随访，采集患者出院后临床结局信息。应用Kaplan-Meier法及Cox回归分析对2组患者进行预后分析。结果：本研究共纳入268例患者：常规降脂方案组230例，强化降脂方案组38例。2组间人口统计学特征和血管危险因素的差异均无统计学意义(均P > 0.05)。强化降脂方案不会显著减少急性非心源性脑梗死合并脑微出血患者缺血性脑卒中复发风险(HR = 0.326, 95% CI 0.076~1.386; P = 0.129)，不会显著增加此类患者自发性脑出血风险(HR = 2.087, 95% CI 0.124~20.393; P = 0.527)，也不会显著减少此类患者全因死亡风险(HR = 0.752, 95% CI 0.171~3.312; P = 0.706)。结论：调脂方案不会影响急性非心源性脑梗死合并脑微出血患者脑卒中复发风险和全因死亡风险。

Abstract: Objective: Our aim was to verify the impact of lipid-lowering therapy on the clinical outcomes of patients with acute non-cardiogenic cerebral infarction combined with cerebral microbleeds (CMBs). Methods: We conducted a single-centered, retrospective, observational cohort study of patients with acute non-cardiogenic cerebral infarction combined with CMBs and treated lipid-lowering therapy between Jan 1, 2016, and Feb 28, 2021 at the Affiliated Hospital of Qingdao University. According to the lipid-lowering therapy, patients were divided into a conventional lipid-lowering therapy group and an intensive lipid-lowering therapy group. During the follow-up period, we collected clinical outcome information after discharge by telephone. We drew Kaplan-Meier curves and constructed Cox proportional hazards regression models to verify the influence of different lipid regulation therapies in prognosis. Results: A total of 268 patients were finally included in this study: 230 in the conventional lipid-lowering therapy group and 38 in the intensive lipid-lowering therapy group. There was no statistically significant difference in demographic characteristics and vascular risk factors between the two groups (all P > 0.05). Intensive lipid-lowering therapy did not significantly reduce the risk of ischemic stroke recurrence in patients with acute non-cardiogenic cerebral infarction combined with CMBs (HR = 0.326, 95% CI 0.076~1.386; P = 0.129). Intensive lipid-lowering therapy also could not significantly increase the risk of intracerebral hemorrhage (HR = 2.087, 95% CI 0.124~20.393; P = 0.527) and reduce the risk of all-cause death (HR = 0.752, 95% CI 0.171~3.312; P = 0.706). Conclusion: The lipid-lowering therapy would not influence the recurrent stroke rate and all-cause mortality in patients with acute non-cardiogenic cerebral infarction combined with CMBs.