Do Statins Afford Neuroprotection in Patients with Cerebral Ischaemia and Stroke?
作者:Carl J. Vaughan、Norman Delanty、Craig T. Basson
DOI:10.2165/00023210-200115080-00002
日期:——
An emerging body of evidence indicates that β-hydroxy-β-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or ‘statins’, provide neuroprotection in addition to reducing ischaemic stroke. Statins reduce the incidence of ischaemic stroke by stabilising atherosclerotic plaques in the precerebral vasculature and through antithrombotic actions, and the neuroprotective effects of statins may confer significant clinical benefit. Some of these neuroprotective effects are likely to be cholesterol independent and mediated by the interruption of isoprenoid biosynthesis. Therapy with statins may modulate endothelial function and preserve blood flow to regions exposed to an ischaemic insult. In particular, statin-mediated preservation of endothelial nitric oxide synthase activity in cerebral vasculature, especially in the ischaemic penumbra, may limit neurological deficit. Moreover, putative anti-inflammatory and antioxidant properties of statins may confer additional neuroprotection. Further large clinical trials are necessary to address the role of statin therapy in the primary prevention of stroke, small vessel cerebrovascular disease and vascular dementia.
越来越多的证据表明,β-羟基-β-甲基戊二酰辅酶 A(HMG-CoA)还原酶抑制剂或 "他汀类药物 "除了能减少缺血性中风外,还能提供神经保护。他汀类药物通过稳定脑前血管中的动脉粥样硬化斑块和抗血栓作用降低缺血性中风的发病率,他汀类药物的神经保护作用可能会带来显著的临床益处。其中一些神经保护作用可能与胆固醇无关,而是通过中断异肾上腺素的生物合成来实现。他汀类药物可调节内皮功能,保护缺血区域的血流。特别是,他汀类药物介导的脑血管内皮一氧化氮合酶活性的保持,尤其是在缺血半影区,可能会限制神经功能的缺失。此外,他汀类药物可能具有的抗炎和抗氧化特性还能提供额外的神经保护作用。他汀类药物在中风、小血管性脑血管病和血管性痴呆的一级预防中的作用还需要进一步的大型临床试验来验证。