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Effect of Statins in Cerebral Hemodynamics and Endothelial Function of Patients with Acute Ischemic Stroke

Author: ChenYaLing
Tutor: DongQiang；FuJianHui；WangYong
School: Fudan University
Course: Neurology
Keywords: transcranial doppler ischemic stroke von Willebrand factor (vWF) thrombomodulin (TM) endothelial progenitor cell (EPC) flow-mediated dilation (FMD)
CLC: R743.3
Type: Master's thesis
Year: 2009
Downloads: 154
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Abstract


Background:Recent studies have demonstrated the effect of statins in both primary and secondary prevention of stroke,and also the reduction of 90-day mortality.The improvement of cerebrovascular reactivity after statin treatment assessed by TCD was evidenced by several studies. Protection of endothelial function reveals to be one of the important mechanisms.Such markers as vWF,thrombomodulin(TM) and flow-mediated dilation(FMD) are most commonly used to evaluate endothelial function, and endothelial progenitor cell(EPC) has emerged as a new marker of endothelial dysfunction in recent years.Objective:To study the effect of statins on vWF and TM levels,count and migration of circulating EPC,and FMD in patients with acute ischemic stroke,and also the impact on hemodynamics and survival benefit.Method:105 inpatients with first-ever ischemic stroke were enrolled within 2 weeks after symptom onset from Apr,2008 to Sep,2008.All patients received organized treatment according to level of serum lipid and risk factors,and plasma vWF and TM antigen concentration and hemodynamics by TCD were examined before therapy.Follow up the above items and prognosis 3 months after stroke.The patients were divided into 3 groups according to actual statin treament as follows,statins group(A),discontinuation group(B) and non-statins group(C).15 patients were treated with 20 mg/d of atorvastatin within 1 week after symptom onset,before and weekly after the initiation of statin treatment,peripheral blood was drawn for detection of EPC counts and migration;In heathy control group(n=9), EPC kinetics was investigated before and biweekly after recruited.FMD and its 3-month follow-up were done in 30 patients who had MCA territory infarct confirmed by MRI,among whom 20 were statins group and 10 were non-statins group.Results:(1)The mean and systolic flow velocity of MCA and ICAex of healthy side in group A significantly increased 3 months after treatment(P<0.05), PI of healthy MCA of the group significantly decreased(P<0.05),while the velocity and PI showed no significant change in group B and C. Proportion of patients with good outcome(mRS≤2) were strikingly higher in group A and C than group B(P<0.05),with no significant difference between the former two groups.(2)The average concentration of plasma vWF and TMwere 1.59±0.09 U/ml and 32.76±3.55 ng/ml within 2 weeks,vWF level decreased in group A after 3 months(P<0.05),while the other two groups didn’t show any significant change.As for TM,group A and C both have an obvious reduction(P<0.05),with former group a larger scale,and group B didn’t have any significant change.TM level of 3 months after stroke was lower in patients with good outcome(mRS≤2) than those with bad ones(mRS>2).The circulating EPC counts gradually increased 2 weeks after statin treatment,and even increased significantly in the 3rd and 4th week(P<0.05);atorvastatin therapy significantly augmented the migration of EPC in the 2nd and 3rd week(P<0.05),which showed a decreasing trend in the 4th week.Neither of the change of EPC counts and migration manifested a correlation with low-density lipoprotein(LDL) lowering.(3)The FMD of patients with continuous statin treatment significantly improved after 3 months[(9.10±2.56)%vs(6.13±1.60)%, P=0.000],and the improvement showed a significant inverse correlation with the change of PI of uninjured MCA(r_s=-0.432,P=0.031),in other words,the more FMD improved,the better compliance the uninjured MCA would get.FMD of non-statins group didn’t show a significant change. 3-month FMD of all patients had a positive correlation with prognosis. Conclusion:Statins treatment in acute ischemic stroke may decrease the plasma level of vWF and TM,augment the count and migration of circulating EPC,and also improve FMD and cerebral hemodynamics.The change of the markers of endothelial function may have an association with good outcome.

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CLC: > Medicine, health > Neurology and psychiatry > Neurology > Cerebrovascular disease > Acute cerebrovascular disease ( stroke)
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