阿托伐他汀钙对动脉瘤性蛛网膜下腔出血后脑血管痉挛的作用及机制

Role of atorvastatin calcium in cerebral vasospasm after aneurysmal subarachnoid hemorrhage and related mechanisms

摘要:

目的 研究阿托伐他汀钙对动脉瘤性蛛网膜下腔出血（aSAH）后血管痉挛（CVS）的影响及机制。方法 连续收集2013年03月至2015年11月收治的动脉瘤性蛛网膜下腔出血患者共62例，随机分为研究组（33例）与对照组（29例）。对照组给予常规治疗，研究组在对照组治疗基础上加服阿托伐他汀钙（20 mg/qn，连服14 d）。于发病后第1天、第3天、第7天和第14天检测分析两组患者大脑中动脉平均血流速度（VMCA）及血清中内皮素血管肽-1（ET-1）、一氧化氮（NO）水平。同时，比较两组患者脑血管痉挛（CVS）的发生率、迟发型脑梗死和复发出血的发生率以及Modified Rankin Scale score量表（mRS）评分。结果 在第7天、第14天研究组的VMCA、ET-1均低于对照组，差异有统计学意义（P<0.05）。在第3天、第7天、第14天，研究组NO含量高于对照组，差异有统计学意义（P<0.05）。研究组脑血管痉挛的发生率较对照组低（36.36% vs. 65.52%），差异有统计学意义（P<0.05）。研究组mRS评分≤2分所占比例较对照组高（75.76% vs. 44.83%），差异有统计学意义（P<0.05）。迟发型脑梗死和再发出血的发生率两组差异无统计学意义（P>0.05）。结论 阿托伐他汀钙能够减少蛛网膜下腔出血后脑血管痉挛的发生，并促进神经功能恢复，其机制可能与改善血管内皮舒缩功能有关。

Abstract:

Objective To investigate the role of atorvastatin calcium in cerebral vasospasm (CVS) after aneurismal subarachnoid hemorrhage (aSAH) and related mechanisms.Methods A total of 62 patients with aSAH who were admitted from March 2013 to November 2015 were enrolled and randomly divided into study group (33 patients) and control group (29 patients). The patients in the control group were given conventional treatment, and those in the study group were given atorvastatin calcium (20 mg/qn for 14 consecutive days) in addition to the conventional treatment. The mean blood flow velocity of the middle cerebral artery (VMCA) and serum levels of endothelin-1 (ET-1) and nitric oxide (NO) were measured at 1, 3, 7, and 14 days after onset. Meanwhile, the incidence rates of CVS, late-onset cerebral infarction, and recurrence of bleeding and Modified Rankin Scale (mRS) score were compared between the two groups.Results At 7 and 14 days after onset, the study group had significantly lower VMCA and serum level of ET-1 than the control group (P<0.05). At 3, 7, and 14 days after onset, the study group had a significantly higher level of NO than the control group (P<0.05). Compared with the control group, the study group showed a significantly lower incidence rate of CVS (36.36% vs. 65.52%, P<0.05) and a significantly higher proportion of patients with an mRS score of ≤2 (75.76% vs. 44.83%, P<0.05). There were no significant differences in the incidence rates of late-onset cerebral infarction and recurrence of bleeding between the two groups (P>0.05).Conclusions Atorvastatin calcium can reduce the occurrence of CVS and promote the recovery of neurological function after subarachnoid hemorrhage, and its mechanisms may be related to the improvement in endothelial vasomotor function.