早期血清胆红素水平对急性脑梗死预后的影响

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摘要目的探讨早期急性脑梗死血清中胆红素水平对预后的影响。方法回顾性分析2016年2～10月延安大学咸阳医院神经内科收治的急性脑梗死患者257例（急性脑梗死组）的临床资料，根据血清胆红素水平又将其分为较高组（≥10.9 μmol/L）和较低组（＜10.9 μmol/L），另设同期30名健康人群为对照组。检测入院第2天的血清胆红素水平，同时对患者入院后的出血性转化（HT）以及多脏器功能障碍综合征（MODS）的发生率进行统计，出院时对预后进行评估，再将不同水平胆红素患者与上述事件进行对比分析。结果急性脑梗死组早期血清胆红素水平明显低于对照组，差异有高度统计学意义（P ＜ 0.01）。不同胆红素水平之间，较低组和较高组HT发生率差异无统计学意义（P ＞ 0.05），而较高组MODS发生率则明显低于较低组，差异有统计学意义（P ＜ 0.05）。与入院时比较，两组出院时神经功能缺损程度评分（NDS）均明显降低，日常生活能力（ADL）评分均明显升高，差异均有高度统计学意义（P ＜ 0.01）。出院时，较高组NDS评分略低于较低组，但差异无统计学意义（P ＞ 0.05），而较高组ADL评分则明显高于较低组，差异有高度统计学意义（P ＜ 0.01）。结论相比正常人群，急性脑梗死患者血清胆红素水平较低，并且在急性脑梗死患者中，胆红素水平越高，患者并发症发生率越低，预后越好。

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	姬利张钦军

关键词 ：急性脑梗死, 胆红素, 出血性转化, 多脏器功能障碍综合征

Abstract：Objective To investigate the effects of early serum bilirubin level on the prognosis of patients with acute cerebral infarction. Methods The clinical data of 257 patients with acute cerebral infarction (acute cerebral infarction group) admitted to Department of Neurology, Xianyang Hospital of Yan'an University from February to October 2016 was analyzed retrospectively, and they were divided into higher group (≥10.9 μmol/L) and lower group (＜10.9 μmol/L) according to different serum bilirubin levels. At the same time, 30 healthy persons were taken as control group. The serum bilirubin level at the second day after admission was detected, and the incidence of hemorrhagic transformation (HT) and multiple organ dysfunction syndrome (MODS) after admission was made statistics, the prognosis at discharge was evaluated, and the patients with different serum bilirubin levels were compared with the events above. Results The early serum bilirubin level of acute cerebral infarction group was lower than that of control group, the difference was highly statistically significant (P ＜ 0.01). During patients with different bilirubin levels, the incidence of HT between lower group and higher group had no statistically significant difference (P ＞ 0.05), while the incidence of MODS in the higher group was lower than that of lower group, the difference was statistically significant (P ＜ 0.05). Compared with those at admission, the scores of neural function deficient scale (NDS) in the two groups at discharge were all decreased, the scores of activity of daily living (ADL) in the two groups at discharge were all increased, the differences were all highly statistically significant (P ＜ 0.01). At discharge, the score of NDS in the higher group was slightly lower than that of lower group, but there was no statistically significant difference (P ＞ 0.05), while the score of ADL in the higher group was higher than that of lower group, the difference was highly statistically significant (P ＜ 0.01). Conclusion Compared with normal persons, the serum bilirubin level of patients with acute cerebral infarction is lower, and among the patients with acute cerebral infarction, the higher the serum bilirubin level is, the lower the incidence of complications is, the better the prognosis is.

Key words： Acute cerebral infarction Bilirubin Hemorrhagic transformation Multiple organ dysfunction syndrome

引用本文:

姬利张钦军. 早期血清胆红素水平对急性脑梗死预后的影响[J]. 中国医药导报, 2017, 14(17): 127-130.
JI Li ZHANG Qinjun. Effects of early serum bilirubin level on the prognosis of patients with acute cerebral infarction. 中国医药导报, 2017, 14(17): 127-130.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I17/127

[1] Lloyd-Jones D，Adams RJ，Brown TM，et al. Executive summary：heart disease and stroke statistics——2010 update：a report from the American Heart Association [J]. Circulation，2010，121（7）：948-954.
[2] Davidson MH，Tomassini JE，Jensen E，et al. Changing characteristics of statin-related cIMT trials from 1988 to 2006 [J]. Atherosclerosis，2016，246：121-129.
[3] Bedi O，Dhawan V，Sharma PL，et al. Pleiotropic effects of statins：new therapeutic targets in drug design [J]. Naunyn Schmiedebergs Arch Pharmacol，2016，389（7）：695-712.
[4] Horsfall LJ，Nazareth I，Petersen I. Cardiovascular events as a function of serum bilirubin levels in a large，statin-treated cohort [J]. Circulation，2012，126（22）：2556-2564.
[5] 盛文利，黄如训.重视脑梗死的出血性转化[J].中国神经精神疾病杂志，2012，38（2）：126-128.
[6] 彭华，郭洪志.急性脑梗死及其并发多脏器功能障碍综合征患者血清C反应蛋白水平的变化[J].临床神经病学杂志，2004，17（5）：330-332.
[7] 陈雁斌.血清尿酸水平与急性脑硬死病情程度的关联性研究[J].中国实用神经疾病杂志，2014，17（9）：84-85.
[8] 王瑞华.日常生活活动能力（ADL）的测定[J].中级医刊，1994（4）：7.
[9] 刘春红，唐娟，余鹃，等.不同血压水平的急性脑梗死患者危险因素及预后分析[J].中国老年学杂志，2012，32（15）：3160-3161.
[10] 宋田，张亚清，周永，等.急性脑梗死早期预后的影响因素[J].中国临床保健杂志，2010，13（5）：460-462.
[11] Mauriello A，Sangiorgi G，Palmieri G，et al. Hyperfibrinogenemia is associated with specific histocytological composition and complications of atherosclerotic carotid plaques in patients affected by transient ischemic attacks [J]. Circulation，2000，101（7）：744-750.
[12] Hernandez-Diaz Y，Tovilla-Zarate CA，Juarez-Rojop I，et al. The role of gene variants of the inflammatory markers CRP and TNF-alpha in cardiovascular heart disease：systematic review and meta-analysis [J]. Int J Clin Exp Med，2015，8（8）：11958-11984.
[13] Oltrona L，Merlini PA，Pezzano A. C-reactive protein and serum amyloid A protein in unstable angina [J]. N Engl J Med，1995，332（6）：399-400.
[14] Minnaard MC，van de Pol AC，Hopstaken RM，et al. C-reactive protein point-of-care testing and associated antibiotic prescribing [J]. Fam Pract，2016，33（4）：408-413.
[15] Ikonomidis I，Michalakeas CA，Lekakis J，et al. Multimarker approach in cardiovascular risk prediction [J]. Dis Markers，2009，26（5/6）：273-285.
[16] Lindley RI，Wardlaw JM，Sandercock PA，et al. Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction [J]. J Stroke Cerebrovasc Dis，2004，13（6）：235-246.
[17] 黄宁芳.出血性脑梗死相关因素的探讨[J].脑与神经疾病杂志，2004，12（2）：125-126.
[18] Ramjee V，Sperling LS，Jacobson TA. Non-high-density lipoprotein cholesterol versus apolipoprotein B in cardiovascular risk stratification：do the math [J]. J Am Coll Cardiol，2011，58（5）：457-463.
[19] Zhou ZX，Chen JK，Hong YY，et al. Relationship Between the Serum Total Bilirubin and Inflammation in Patients With Psoriasis Vulgaris [J]. J Clin Lab Anal，2016，30（5）：768-775.
[20] Idelman G，Smith DL，Zucker SD. Bilirubin inhibits the up-regulation of inducible nitric oxide synthase by scavenging reactive oxygen species generated by the toll-like receptor 4-dependent activation of NADPH oxidase [J]. Redox Biol，2015，5：398-408.
[21] 戴晓慧，朱月潜.新诊断高血压患者颈动脉内中膜厚度和C反应蛋白的研究[J].诊断学理论与实践，2011，10（5）：471-474.
[22] Erdogan D，Gullu H，Yildirim E，et al. Low serum bilirubin levels are independently and inversely related to impaired flow-mediated vasodilation and increased carotid intima-media thickness in both men and women [J]. Atherosclerosis，2006，184（2）：431-437.
[23] Luo Y，Li JW，Lu ZJ，et al. Serum bilirubin after acute ischemic stroke is associated with stroke severity [J]. Curr Neurovasc Res，2012，9（2）：128-132.