急性脑出血继发高胆红素血症的临床特征分析

Analysis of clinical features of hyperbilirubinemia secondary to acute intracerebral hemorrhage

目的分析急性脑出血患者继发高胆红素血症的临床特征,为临床诊疗提供一定指导。方法回顾性分析南京医科大学第一附属医院2020年1-12月收治的213例急性脑出血住院患者的临床资料,根据患者入院24 h内血清胆红素结果,将急性脑出血患者分为高胆红素血症组(71例)和正常胆红素组(142例)。比较2组患者的基本资料、既往病史、血清学结果、脑出血部位、出血量、是否破入脑室,以及入院24 h内的美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(mRS)评分等。结果213例患者中,发生高胆红素血症71例,发生率为33.33%。2组患者年龄、性别、既往病史、白细胞、血小板、血糖、肌酐、出血量及NIHSS和mRS评分比较,差异均无统计学意义(P>0.05)。高胆红素血症组患者血肿部位在丘脑区的比例[50.70%(36/71)]高于正常胆红素组[15.49%(22/142)],而正常胆红素组患者血肿部位在基底节区的比例[51.41%(73/142)]高于高胆红素血症组[14.08%(10/71)],差异均有统计学意义(P<0.05)。高胆红素血症组脑出血患者血肿破入脑室的比例[52.11%(37/71)]高于正常胆红素组[25.35%(36/142)],差异有统计学意义(P<0.05)。结论急性脑出血继发高胆红素血症患者出血部位多位于丘脑区,并且血肿容易破入脑室。

Objective To analyze the clinical features of the patients with hyperbilirubinemia secondary to acute intracerebral hemorrhage and provide some guidance for clinical diagnosis and treatment.Methods The clinical data of 213 patients with acute intracerebral hemorrhageadmitted to the First Affiliated Hospital of Nanjing Medical University from January to December 2020 were retrospectively analyzed.According to the results of serum bilirubin within 24 h after admission,the patients with acute intracerebral hemorrhage were divided into the hyperbilirubinemia group(71 cases)and the normal bilirubin group(142 cases).The basic data,previous medical history,serological results,site of intracerebral hemorrhage,hemorrhage volume,whether the ventricles were broken into,and the National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)scores within 24 h of admission were compared between the two groups.Results Among the 213 patients,71 cases developed hyperbilirubinemia,with an incidence of 33.33%.There were no significant differences in age,gender,previous medical history,leukocytes,platelets,blood glucose,creatinine,bleeding volume,NIHSS and mRS scores between the two groups(P>0.05).The proportion of patients in the hyperbilirubinemia group with hematoma sites in the thalamus[50.70%(36/71)]was higher than that in the normal bilirubin group[15.49%(22/142)],while the proportion of patients in the normal bilirubin group with hematoma sites in the basal ganglia region[51.41%(73/142)]was higher than that in the hyperbilirubinemia group[14.08%(10/71)],with statistically significant differences(P<0.05).The proportion of hematoma breaking into the cerebral ventricle in thepatients with intracerebral hemorrhage in the hyperbilirubinemia group[52.11%(37/71)]was higher than that in the normal bilirubin group[25.35%(36/142)],and the difference was statistically significant(P<0.05).Conclusion The bleeding site of patients with hyperbilirubinemia secondary to acute intracerebral hemorrhageis mostlylocated in the thalamus and the hematoma easilybreaks intothe cerebralventricle.