血清胆红素与脑梗死急性期患者的关系

Relationship between serum bilirubin and patients with acute cerebral infarction

目的探讨脑梗死急性期患者的血清胆红素水平及其与患者病情和预后的关系。方法选择符合诊断标准的脑梗死急性期(发病≤2周)患者177例,基本资料相匹配的非急性期脑梗死(发病>2周)患者38例、对照组102例。检测各组入院<72h的血清总胆红素、直接胆红素水平,计算间接胆红素值,并检测血脂、血糖、超敏C反应蛋白、纤维蛋白原等生化指标。对急性期组于入院当天采用美国国立卫生研究院卒中量表(NIHSS)评定神经功能缺损情况,于发病后3个月采用改良Rankin量表(mRS)进行预后评估。结果①脑梗死急性期组的血清总胆红素、直接胆红素水平明显高于非急性期组及对照组(P<0.05,或P<0.01);间接胆红素水平仅高于非急性期组,差异有统计学意义(P<0.05)。非急性期组的三种血清胆红素水平均低于对照组,但差异无统计学意义。②随着神经功能缺损严重程度的增加,脑梗死急性期组三种胆红素水平均有升高趋势,但差异无统计学意义(P>0.05)。③发病后3个月,脑梗死急性期组中,预后良好(mRS为0～2分)者入院时的血清总胆红素、直接胆红素水平均高于预后不良者(mRS为3～5分),差异有统计学意义(P<0.05)。④多因素Logistic回归分析显示,血清总胆红素升高与预后良好独立相关(OR=0.807,95%CI:0.718～0.907,P<0.01)。结论脑梗死急性期患者血清胆红素水平呈应激性升高,血清胆红素水平的增高与神经功能缺损程度无显著相关,但与预后良好有相关性。急性期胆红素水平的增高可能为机体对卒中事件的一种保护性防御反应。

Objective To investigate the serum bilirubin level in patients with acute cerebral infarction and its relationship with the prognosis. Methods A total of 177 patients with acute cerebral infarction （onset ≤2 weeks） were met the diagnostic criteria, 38 patients whose basic information were matched but without acute cerebral infarction （onset 〉 2 weeks） , and 102 controls were selected. The serum bilirubin level and direct bilirubin level were detected at 72 hours after admission in all groups, the indirect bili- rubin value was calculated, and the biochemical indexes, such as blood lipids, blood glucose, high sensi- tive C-reactive protein and fibrinogen （FIB） were detected. Neurological deficit in the acute cerebral in- farction group was assessed on the day of admission using the National Institutes of Health Stroke Scale （NIHSS）. The prognostic evaluation was conducted using the modified Rankin scale （mRs） at 3 months after the onset of stroke. Results ①The serum bilirubin and direct bflirubin levels in the acute cerebral infarction group were significantly higher than those in the non-acute cerebral infarction group （ P 〈 0.05 ） and control group or （ P 〈 0.01 ）, and the indirect bilirubin level only higher than that of the non-acute cerebral infarction group （P 〈0.05）. The mean level of the three kinds of serum bilirubin in the non-acute cerebral infarction group was lower than that in the control group; however, there was no significant difference. ②With the increased severity of neurological deficit in the acute cerebral infarction group, the mean levels of the 3 kinds of bilirubin tended to increase, however, there was no significant difference （P 〈 0. 05）. ③Three months after the onset, both the serum total bilirubin and direct bilirubin levels al admis- sion in patients with good prognosis （ mRs, 0 to 2） in the acute cerebral infarction group were higher than those with poor prognosis （ mRs, 3 to 5 ）. The differences were statistically significant （ P 〉 0. 05 ）. ④Multivariate logistic regression analysis showed that the increased serum total bilirubin level was independently associated with the good prognosis （ OR, 0. 807, 95% CI： 0. 718 - 0. 907. P 〈 0. 01 ）. Conclusion The serum bilirubin levels showed stressful increase in patients with acute cerebral infarction. The increased serum bilirubin level is not significantly associated with the severity of neurological deficit, but it is associated with good prognosis. The increased serum bilirubin level may be a protective defense response of the body for stroke events.