达丁类药物治疗用于二次预防缺血性中风患者与大脑微型出血
Luis Prats-Sanchez1, Pol Camps-Renom1, Philip S Nash1
1From the Department of Neurology (L.P.-S., P.C.-R., A.R.-P., A.M.-D., J.M.-F.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Stroke Research Centre (P.S.N., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology; Department of Statistical Science (G.A., J.G.B.), University College London, United Kingdom; Biomedical Research Institute Sant Pau (M.G.-J., Á.L.-G., G.E.D., D.G.-A.), Barcelona, Spain; UCL Stroke Research Centre (H.D.), Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom; Stroke Research Centre, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, People's Republic of China; Centre for Clinical Brain Sciences (R.A.-S.S.), School of Clinical Sciences, University of Edinburgh, United Kingdom; Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London; Lysholm Department of Neuroradiology, The National Hospital of Neurology and Neurosurgery, Queen Square London; Liverpool Centre for Cardiovascular Science at University of Liverpool (G.Y.L.), Liverpool John Moores University and Liverpool Heart & Chest Hospital, United Kingdom; and Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark; A.A. Martinos Center for Biomedial Imaging (H.A.), Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston; Takeda Pharmaceutical Company Limited, Cambridge, MA; Department of Neurology (S.J.), University Hospital Inselspital Bern, University of Bern, Switzerland; Department of Neurology (N.M.B.), Tel-Aviv Sourasky Medical Center; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Department of Neurology (T.G., S.E.); Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Department of Radiology and Nuclear Medicine (D.H.D.-N.), Erasmus MC, Rotterdam, The Netherlands; Department of Cerebrovascular Medicine (M.K., K.T.), National Cerebral and Cardiovascular Centre, Osaka, Japan; Department of Neurology (F.F.), University Hospital of Würzburg, Germany; Stroke and Ageing Research Group (T.G.P.), School of Clinical Sciences at Monash Health; Peninsula Clinical School (V.K.S.), Peninsula Health, Monash University; National Centre for Healthy Ageing, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; The Neurovascular Research Unit and Health Research Board (P.J.K.), Stroke Clinical Trials Network Ireland, University College Dublin; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Kushiro, Japan; Department of Neurology (J.S., S.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, The Netherlands; Department of Neurology (Y.Y.), Kansai Medical University, Osaka, Japan; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey; Calgary Stroke Program (E.E.S.), Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary; Centre for Clinical Brain Sciences (J.M.W., F.M.C.), Edinburgh Imaging; and UK Dementia Institute at the University of Edinburgh; Centre for Rural Health (S.D.M.), University of Aberdeen, United Kingdom; Department of Neurology (J.-L.M., D.C.), GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Univ. Lille (R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Lille, France; Memory Aging and Cognition Centre (C.P.C.), Yong Loo Lin School of Medicine, National University of Singapore,; Department of Brain Sciences (R.V.), Imperial College London, United Kingdom; Department of Neurology, Heidelberg University Hospital, Germany; Department of Neurology (N.K.), National Neuroscience Institute, Singapore; Stroke Research Centre (R.J.S.), Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology; Comprehensive Stroke Service, University College London Hospitals NHS Trust, United Kingdom; Department of Neurology (F.-E.D.L.), Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Neurology and Stroke Centre (S.T.E.), University Hospital Basel and University of Basel; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER; University of Basel, Switzerland; Department of Neurology and Stroke Centre (N.P.), University Hospital Basel and University of Basel; Stroke Center Klinik Hirslanden Zürich, Switzerland; Division of Neurology (Y.O.S.), Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong; Department of Neurology and Stroke Centre (A.Z.), University Hospital Basel and University of Basel, Switzerland; Department of Radiology (J.H.), University Medical Center Utrecht; and Department of Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center/Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands.
在缺血性中风 (IS) 或过渡性缺血性发作 (TIA) 后,在患有脑微出血症 (CMB) 的患者中使用他类药物可以降低复发性中风的风险. 这种疗法降低了整体中风和IS风险,而不会增加内出血 (ICrH) 风险.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 医疗成像医学成像
背景情况:
- 在患有缺血性中风 (IS) 或过渡性缺血性发作 (TIA) 的患者中,大脑微型出血 (CMB) 是常见的.
- 在这种患者群体中,他类药物治疗的安全性和有效性,特别是关于内出血风险 (ICrH) 的安全性和有效性,仍然不确定.
研究的目的:
- 调查他类药物使用与CMB患者中复发性IS和ICrH风险之间的关联.
- 确定他类药物治疗是否影响CMB患者中任何中风,单独IS或单独ICrH的风险.
主要方法:
- 来自32项前性研究的个人患者数据的聚合分析 (Microbleeds国际合作网络).
- 包括IS或TIA的成年患者和可用的基线MRI用于CMB量化.
- 复发性症状性中风 (IS或ICrH) 的随访,考克斯回归分析对关键临床因素进行调整.
主要成果:
- 在CMB患者中,静止剂治疗与任何中风 (aHR 0.68) 和IS (aHR 0.65) 的风险降低有关.
- 在他类药物使用和ICrH风险 (aHR 0.73) 之间没有发现显著的关联.
- 这些发现在不同的CMB分布和负担中保持一致.
结论:
- 在IS/TIA和CMB患者中,使用他类药物的二次中风预防与复发性中风和IS的风险降低有关.
- 在这个队列中,使用他类药物似乎不会增加内出血的风险.
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