杨弘文　汤春琼　区嘉欢

[摘要] 目的 探讨急性缺血性脑卒中患者既往服用他汀类药物与谵妄风险之间的关系。 方法 2014年1月～2016年12月选取本院符合标准的急性缺血性脑卒中患者576例，根据入院前是否服用他汀类药物分为他汀组和非他汀组，比较两组的谵妄发生率。并采用多因素Logistic回归分析评价他汀类药物对急性缺血性脑卒中后谵妄的影响。 结果 576例脑梗死患者纳入观察，在入院4天内的筛查中，发现104名谵妄患者。其中他汀组发生谵妄36例，非他汀组发生谵妄68例；两组比较差异有统计学意义（χ2=8.093，P<0.05）。多元Logistic回归分析表明：既往服用他汀类药物与急性缺血性脑卒中后谵妄的发生率降低显著相关[odds ratio（OR），0.527；95%CI，0.382～0.708]。谵妄患者他汀组平均住院时间短于非他汀组，差异有统计学意义（t=3.137，P<0.05）；但两组3个月后NIHSS评分比较差异均无统计学意义（P>0.05）。 结论 既往服用他汀类药物可能与急性缺血性脑卒中后谵妄的发生率降低有关。

[关键词] 脑卒中；谵妄；他汀类药物；危险因素

[中图分类号] R743.3 [文獻标识码] B [文章编号] 1673-9701（2018）20-0047-03

Analysis of the relationship between statins and delirium after acute ischemic stroke

YANG Hongwen TANG Chunqiong OU Jiahuan LI Quhong

Department of Neurology， Nanhai Hospital of Southern Medical University， Foshan 528244， China

[Abstract] Objective To investigate the relationship between statins and the risk of delirium in patients with acute ischemic stroke. Methods 576 patients with acute ischemic stroke who met the criteria in our hospital from January 2014 to December 2016 were enrolled. According to whether they took statins before admission， they were divided into statin group and non-statin group. The incidence of delirium was compared between the two groups. Multivariate logistic regression analysis was used to evaluate the effect of statins on delirium after acute ischemic stroke. Results A total of 576 patients with cerebral infarction were enrolled. In the screening within 4 days of admission， 104 patients with delirium were found. Among them， 36 cases of delirium occurred in the statin group and 68 cases occurred in the non-statin group. The difference between the two groups was statistically significant（χ2=8.093， P<0.05）. Multivariate logistic regression analysis showed that the previous administration of statins was significantly associated with a reduced incidence of delirium after acute ischemic stroke[odds ratio（OR）， 0.527； 95% CI， 0.382-0.708]. The average hospital stay in the statin group was shorter than that in the non-statin group， and the difference was statistically significant（t=3.137， P<0.05）. However， there was no significant difference in the NIHSS score between the two groups after 3 months（P>0.05）. Conclusion Previous administration of statins may be associated with a reduced incidence of delirium after acute ischemic stroke.

[Key words] Stroke； Delirium； Statins； Risk factors

谵妄是脑梗死患者常见的并发症，是一种与长期认知障碍存在联系的急性脑损伤[1]，有较高的病死率。研究发现脑卒中后谵妄可以引起持续的认知功能损害，且增加了患者的死亡率[2]。他汀类药物是一种羟甲基戊二酰辅酶A（hydroxy methylglutaryl coenzyme A，HMG-CoA）还原酶阻滞剂，近年来，一些研究人员认为他汀类药物因其多效性，能预防和治疗谵妄的发生，其多效性包括抗炎反应、免疫介导、增强内皮作用和抗凝固的作用[3]。目前国内外针对脑卒中后谵妄（poststroke delirium，PSD）与他汀类药物关系的研究较少。本文就脑梗死后谵妄患者的危险因素与既往服用他汀类药物关系作一研究。

1 资料与方法

1.1 临床资料

选择2014年1月～2016年12月在南方医科大学南海医院神经内科序贯住院的符合入选标准的首次发病的急性缺血性脑卒中患者576例，平均年龄（68.7±7.2）岁。……