胆红素水平与急性缺血性脑卒中及其亚型的相关性

Relationship of Bilirubin with Acute Ischemic Stroke and Chinese Ischemic Stroke Subclassification

目的：探讨胆红素水平与急性缺血性脑卒中（AIS）发病、中国缺血性脑卒中亚型（CISS）、卒中严重性及短期预后的关系。方法 AIS住院患者616例（AIS组），性别和年龄匹配的非脑卒中住院患者664例（对照组），比较两组临床资料并进行非条件Logistic回归分析。对AIS患者进行CISS分型，比较各亚型间胆红素水平。将AIS患者分为胆红素升高组和胆红素正常组，比较两组入院和出院时美国国立卫生研究院卒中量表（NIHSS）评分及神经功能好转率。结果 AIS组总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）水平均明显高于对照组（P〈0.01）；Logistic回归分析显示，TBIL为AIS的独立危险因素（OR=1.026,95%CI 1.012~1.041, P〈0.001）。CISS各亚型间TBIL、DBIL、IBIL水平均无显著性差异（P〉0.05）。胆红素升高组入院NIHSS评分大于正常组（P〈0.05）；两组患者出院NIHSS评分、神经功能好转率均无显著性差异（P〉.05）。结论 AIS患者血清胆红素升高，与入院时病情严重程度相关，是AIS发病的危险因素；胆红素水平在CISS亚型间分布无显著性差异，对AIS患者短期预后无明显影响。

Objective To investigate the relationship of the serum bilirubin level with acute ischemic stroke （AIS）, and Chinese isch-emic stroke subclassification （CISS）, stroke severity and short-term outcome of AIS patients. Methods 616 patients with AIS as well as 664 patients without stroke matched with gender and age were compared and analyzed with the non-conditional Logistic regression. The AIS pa-tients were divided based on the CISS, and their bilirubin levels were compared. The AIS patients were divided into high bilirubin group and normal bilirubin group, their scores of the National Institute of Health Stroke Scale （NIHSS） as admission and discharge, and neural func-tion improvement rate were compared. Results The levels of total bilirubin （TBIL）, direct bilirubin （DBIL） and indirect bilirubin （IBIL） were higher in the AIS group than in the control group （P〈0.01）, and the TBIL was the independent risk factors of AIS （OR=1.026, 95%CI 1.012-1.041, P〈0.001）. There was no significant difference of the levels of TBIL, DBIL and IBIL among the patients of CISS （P〉0.05）. The NIHSS score was higher in the high bilirubin group than in the normal bilirubin group as admission （P〈0.05）, but it was not significant as discharge （P〉0.05）, nor the rate of neural function improvement （P〉0.05）. Conclusion The serum bilirubin level elevated and correlated with the severity in the AIS patients, which might be the risk of pathogenesis and AIS. The bilirubin was not various with the CISS, and might be less involved in the short-term outcome of AIS.