急性缺血性卒中患者血清胆红素水平与病情严重程度和短期转归的关系

目的：探讨急性缺血性卒中患者血清胆红素水平与病情严重程度和短期转归的关系。方法纳入连续的120例急性缺血性卒中住院患者，105例同期健康体检者作为对照组。在入院24 h内检测血清总胆红素、直接胆红素、间接胆红素以及血脂、血糖等生化指标，入院当天采用美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS ）评定神经功能缺损情况，NIHSS评分<8分定义为轻度卒中，≥8分定义为中重度卒中。在出院时或发病后14 d采用改良 Rankin 量表（modified Rankin Scale, mRS）评估临床转归，0~2分定义为转归良好，>2分定义为转归不良，并再次检测血清总胆红素、直接胆红素和间接胆红素水平。结果中重度卒中组血清总胆红素、直接胆红素和间接胆红素水平均显著高于轻度卒中组（P ＜0.01）和对照组（P ＜0.01）。多变量 logistic 回归分析显示，血清总胆红素优势比（odds ratio, OR）1.855，95％可信区间（confidence interval, CI）1.390~2.475；P ＜0.01]、间接胆红素（OR 3.380，95％ CI 1.271~11.901；P ＜0.05）和直接胆红素（OR 3.51，95％ CI 1.062~11.473；P ＜0.01）水平升高均与基线病情严重程度存在显著独立相关性。单变量分析显示，入院时血清总胆红素水平升高与短期转归不良有关（P ＜0.05），但校正其他混杂因素后丧失统计学意义（OR 2.411，95％ CI 0.803~7.243；P >0.05）。结论脑梗死急性期患者血清胆红素水平呈应激性升高，并且与神经功能缺损程度存在显著相关性，但与短期转归无关，可能是机体对卒中事件的一种防御反应。

Relationship between the serum bilirubin level and the severity of disease and short -term outcome in patients w ith ischemic stroke

Objective To investigate the relationship betw een the serum bilirubin level and the severity of disease and short-term outcome in patient w ith acute ischemic stroke. Methods A total of 120 consecutive inpatients w ith acute ischemic stroke w ere enroled and 105 healthy subjects at the same time w ere used as a control group. The biochemical indicators, such as serum total bilirubin, direct bilirubin, indirect bilirubin, blood lipid, and blood glucose w ere measured w ithin 24 h after admission. The National Institutes of Health Stroke Scale ( NIHSS ) w as used to assess the neurological deficits on the day of admission. The NIHSS score <8 w as defined as mild stroke and ≥8 w as defined as moderate to severe stroke. At discharge or 14 d after onset, the modified Rankin Scale (mRS) w as used to evaluate the clinical outcomes, 0-2 w as defined as good outcome and > 2 w as defined as poor outcome. The levels of serum total bilirubin, direct bilirubin, and indirect bilirubin w ere measured again. Results The levels of serum total bilirubin, direct bilirubin, and indirect bilirubin in the moderate to severe stroke group w ere significantly higher than those in the mild stroke group ( P <0.01) and the control group ( P <0.01). Multivariate logistic regression analysis show ed that the increased levels of serum total bilirubin (odds ratio OR] 1.855,95%confidence interval CI] 1.390-2.475; P <0.01), indirect bilirubin ( OR 3.380, 95%CI 1.271-11.901; P <0.05), and direct bilirubin ( OR 3.51, 95%CI 1.062-11.473; P <0.01) had significantly independent correlation w ith baseline disease severity. Univariate analysis show ed that the increased serum total bilirubin level on admission w as associated w ith the short-term poor outcome ( P <0.05), but after adjustment for other confounding factors, there w as no statistical significance ( OR 2.411, 95%CI 0.803-7.243, P >0.05). Conclusions The serum bilirubin level show ed stress increase in patients w ith cerebral infarction in acute phase; and it w as significantly associated w ith the degree of neurological deficit, but it w as not associated w ith short-term outcome. It might be a defense response to the body for stroke events.