糖尿病合并急性缺血性卒中患者的机体胆红素水平变化及其临床意义

Change and significance of bilirubin in the patients of acute ischemic stroke with diabetes mellitus

目的 探讨糖尿病合并急性缺血性卒中机体胆红素水平的变化及其临床意义.方法⑴分析2008年10月至2012年9月本科住院的610例急性缺血性卒中患者,根据有无合并糖尿病分为糖尿病组(202例)和非糖尿病组(408例),另选取同期住院并经头颅磁共振排除新发脑梗死的后循环缺血患者138例作为基线对照,亦分为糖尿病组(31例)和非糖尿病组(107例),并记录所有患者的血清总胆红素、直接胆红素等.⑵无论是急性缺血性卒中还是非缺血性卒中患者,均比较糖尿病组和非糖尿病组间血清总胆红素、直接胆红素水平的差异.结果 ⑴在急性缺血性卒中人群,糖尿病组的总胆红素[(17.085±0.595)μmol/L vs(18.920±0.487)μmol/L,P=0.024]、直接胆红素水平[(4.362±0.147)μmol/L vs(4.876±0.135)μmol/L,P=0.019]均明显低于非糖尿病组;⑵在非缺血性卒中人群,糖尿病组和非糖尿病组的总胆红素、直接胆红素水平差异无统计学意义(P>0.05).结论急性缺血性卒中诱导的胆红素水平升高可被糖尿病有效抑制,这可能是糖尿病加重缺血性卒中脑损害的机制之一.

Objective To investigate the change and possible role of bilirubin between with and without diabetes mellitus in the population of acute ischemic stroke. Methods ⑴A total of 610 hospitali-zation patients at the Department of Neurology in Affiliated Drum Tower Hospital of Nanjing University Medi-cal School from October 2008 to September 2012, who were diagnosed as acute ischemic stroke was divided into two groups based on diabetes mellitus or not, and 138 hospitalization patients with vertigo or dizzy diag-nosed as posterior ischemic while had no acute ischemic stroke were set as a control, divided into two groups based on the same standard too. Also, serum direct bilirubin and total bilirubin and new infarction or not were recorded. ⑵The levels of direct bilirubin and total bilirubin were compared between groups of diabetes and without diabetes, whatever in the population of acute ischemic stroke or not. Results ⑴The levels of serum total bilirubin and direct bilirubin were decreased obviously in the group of diabetes mellitus compared to the group of non-diabetes mellitus in the population of acute ischemic stroke [(17. 085 ± 0. 595)μmol/L vs (18. 920 ± 0. 487)μmol/L, P=0. 024;(4. 362 ± 0. 147)μmol/L vs (4. 876 ± 0. 135)μmol/L, P =0. 019 ] . ⑵There were no obvious difference of serum total bilirubin and direct bilirubin between the groups of diabetes mellitus and non-diabetes mellitus in the population of non-ischemic stroke ( P>0. 05 ) . Con-clusions Induction of bilirubin by acute ischemic stroke can be inhibited by diabetes mellitus, which may be one of the mechanisms of deteriorative brain damage by diabetes mellitus after acute ischemic stroke.