急性脑梗死溶栓后出血转化患者血清胆红素水平变化观察

Changes in serum bilirubin in hemorrhagic transtofmation patients after treatment of intravenous thrombolysis for acute ischemic stroke

目的观察急性脑梗死静脉溶栓后出血转化患者血清胆红素水平变化,并探讨其临床意义。方法接受静脉溶栓治疗的脑梗死患者300例,根据溶栓后24 h内复查头颅CT或MRI评估有无出血转化,分为出血转化组和非出血转化组,比较两组入院时血清胆红素。将血清胆红素与脑梗死溶栓后出血转化之间作多因素Logistic回归分析。采用ROC评估血清胆红素对脑梗死溶栓后出血转化预测的准确度。结果300例患者中,有45例(15%)发生溶栓后出血转化。出血转化组与非出血转化组血清直接胆红素、间接胆红素、总胆红素比较,P均<0.05。血清间接胆红素、总胆红素是脑梗死溶栓后出血转化的独立危险因素(OR=1.419:95%CI 1.003~2.007,P<0.05;OR=1.120:95%CI 1.060~1.182,P<0.05)。血清间接胆红素预测脑梗死溶栓后出血转化的ROC下面积为0.729(95%CI 0.646~0.812,P<0.05),最佳诊断界值为13.50,灵敏度为55.6%,特异度为83.9%。血清总胆红素预测急性脑梗死溶栓后出血转化的ROC下面积为0.720(95%CI 0.637~0.802,P<0.05),最佳预测界值为16.15,灵敏度为0.578,特异度为0.812。结论急性脑梗死溶栓后出血转化患者入院时血清胆红素升高,血清间接胆红素、总胆红素是急性脑梗死溶栓后出血转化的独立危险因素,检测血清胆红素水平有助于预测急性脑梗死溶栓后是否发生出血转化。

Objective To study the expression changes and clinical significance of serum bilirubin in hemorrhagic transtofmation(HT)patients after intravenous thrombolysis for acute ischemic stroke(AIS).Methods We consecutive⁃ly recruited 300 patients who suffered AIS within 4.5 hours from the symptoms onset and received intravenous thrombolysis(IVT).All patients underwent post-thrombolysis brain computed tomography scan within 24 hours or magnetic resonance imaging study.Depending on whether HT occurred,the patients were divided into two groups:the HT group and non-HT group.Serum bilirubin was obtained and compared among patients between different groups.Multivariate Logistic regres⁃sion analysis was used to explore the relationship between serum bilirubin and HT.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of serum bilirubin for HT after intravenous thrombolysis for AIS.Re⁃sults Among 300 patients,45(15%)cases had HT.There were significant differences in the direct bilirubin,indirect bilirubin,and total bilirubin between the HT group and non-HT group(all P<0.05).The indirect bilirubin and total bili⁃rubin(OR=1.419:95%CI:1.003-2.007,P<0.05;OR=1.120:95%CI:1.060-1.182,P<0.05)were independent risk factors for HT.Based on the ROC curve,the area under the curve(AUC)of indirect bilirubin in predicting HT was 0.729(95%CI:0.646-0.812,P<0.05),and the optimal cut-off value was 13.5,(specificity,0.556;sensitivity,0.839).The AUC of total bilirubin in predicting HT was 0.718(95%CI:0.637-0.802,P<0.05),and the optimal cutoff value was 16.15,with the specificity of 0.578,and sensitivity of 0.812.Conclusions Serum bilirubin level is ele vated in HT patients after intravenous thrombolysis for AIS,Serum indirect bilirubin and total bilirubin are independent risk factors for HT.Serum bilirubin level may predict HT after intravenous thrombolysis in AIS patients.