<International Circulation>:Evidence shows that statins are effective in ameliorating cerebral vasospasms. What are the possible mechanisms for statin mediated attenuation of cerebral vasospasms？

   《国际循环》：有证据表明他汀类药物能够有效的改善脑血管痉挛，其可能的作用机制是什么？
    Dr Sherry Chou: I would go back and say that I am not sure if statins ameliorate vasospasms or improve outcome of subarachnoid haemorrhage.There are definitely a number of small clinical studies that have shown a favourable trend but the end results have not been validated in terms of large scale clinical trials.  This is certainly what we are missing right now to see whether or not there is a role for statins. In terms of mechanisms; there are many potential mechanisms: in subarachnoid haemorrhage and vasospasms there is a global deficiency in nitric oxide and the activity of endothelial nitric oxide synthase is clearly downregulated by subarachnoid haemorrhage and statins have an affect of upregulating such receptors. This is just one of several possible mechanisms and the key is to understand that statins have multiple effects and there are multiple things that happen during vasospasm which makes statins a particularly attractive therapeutic option.

    Sherry Chou教授：实际上我们还不能肯定他汀类药物能够缓解脑血管痉挛或改善蛛网膜下腔出血患者的预后。的确有一些小规模临床研究显示有获益趋势，但终点结局还没有得到大规模临床试验的证实。他汀对此能否发挥作用，正是我们迫切希望明确的问题。他汀有许多潜在的作用机制：蛛网膜下腔出血、脑血管痉挛的患者中普遍存在一氧化氮缺失和内皮型一氧化氮合酶活性下调，而他汀具有上调相关受体的作用。当然这仅是可能的作用机制之一，关键是血管痉挛过程中会发生多种病理变化，而他汀的多效性使其成为备受关注的治疗选择之一。
    <International Circulation>:Could statins improve the outcome of subarachnoid haemorrhage? 

   《国际循环》：他汀能否改善蛛网膜下腔出血患者的结局？
    Dr Sherry Chou: I would hope so but the data we have at present is mixed. My feeling is that it may well be but it probably needs to be started very early. But the thing we need to do to see if this is the case is to perform a well designed multicenter trial to really understand if this is actually true.

    Sherry Chou教授：我们希望如此，但是截至目前证据不足。我个人感觉他汀治疗可能对改善蛛网膜下腔出血患者的预后有益，但需要极早开始。我们目前需要是实施一项设计良好的多中心临床试验以确切证实这一点。
    <International Circulation>:  Do you think prior use of statins will lower the risk of vasospasms in patients with subarachnoid haemorrhage?

   《国际循环》：您认为预防性应用他汀类药物能否降低蛛网膜下腔出血患者发生血管痉挛的风险？
    Dr Sherry Chou: There are two small trials which have shown a positive outcome; but the trial which I was involved in we did not see much of a difference. Sitting here I really can’t answer that question but we can always do a clinical trial and find out. 

    Sherry Chou教授：已有2项小规模临床试验显示出阳性结果，但另外一项我本人参与的试验未能观察到显著差异。所以目前还不能明确回答这一问题，但我们总是能够通过临床试验来找到答案。
    <International Circulation>: Is there an appropriate time to use statins after subarachnoid haemorrhage?

   《国际循环》：蛛网膜下腔出血患者发病后服用他汀类药物的最佳时间是什么？
    Dr Sherry Chou:From the data we have at present I cannot quote a specific time but the data suggests that the earlier the better. Ideally for all neurological diseases if you take a statin before the incident it is probably best but that is clearly not reality.

    Sherry Chou教授：从目前掌握的资料看，还不能给出一个确切的最佳用药时间，但这些资料能够提示越早服药效果越好，对于存在神经疾患的患者来说在发病前应用他汀类药物可能是最佳选择，但目前尚未得到证实。
Dr Sherry Hsiang Yi Chou is a practising physician at Brigham and Women’s Hospital， Boston， Massachusetts and was an invited speaker at TISC 2010.