Association of serum bilirubin with ischemic stroke outcomes.
Association of serum bilirubin with ischemic stroke outcomes.
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DOI：
10.1016/j.jstrokecerebrovasdis.2008.01.009
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发表时间：
2008-05-01
期刊：
影响因子：
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通讯作者：
Ovbiagele, Bruce
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文献类型：
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作者：
Pineda, Sandra;Bang, Oh Young;Ovbiagele, Bruce
背景技术背景：较高水平的血清胆红素可能在氧化应激介导的疾病中提供治疗优势，但也可能仅仅反映氧化应激的强度。关于胆红素在中风中的作用知之甚少。我们评估了血清胆红素水平与缺血性中风住院患者的临床表现和预后之间的关系。方法：前瞻性收集数据，在5年期间连续缺血性中风入院的大学医院。入院时测定血清总胆红素（Tbil）和直接胆红素（Dbil）水平。采用美国国立卫生研究院卒中量表（NIHSS）评估卒中严重程度。出院时的功能结果采用改良兰金量表进行评估。结果：在743例患者中，平均年龄为67.3岁，47.5%为女性。中位NIHSS评分为4分，24%的患者出院时功能结局较差（改良兰金量表4-6分）。DBil水平越高，卒中严重程度越高（P = 0.001），出院结果越差（P = 0.034）。多变量回归分析显示，与较低水平（<或=0.1 mg/dL）的患者相比，具有较高Dbil水平（>或=0.4 mg/dL）的患者具有显著更高的入院NIHSS评分（比值比2.79，95%置信区间1.25-6.20，P = 0.012），但没有证实Dbil与出院结局之间存在独立关系。虽然更高的入院TBIL与更大的中风严重程度的粗分析（P = 0.003），TBIL与中风严重程度或结果之间没有独立的关系，注意到调整后的混杂因素。结论：更高的DBIL水平与更大的中风严重程度，但缺血性中风患者的结果，可能反映了强度的初始氧化应激。需要进一步研究这种关系的潜在病理生理学。
BACKGROUND: Higher levels of serum bilirubin may offer a therapeutic advantage in oxidative stress-mediated diseases, but may also simply reflect intensity of oxidative stress. Little is known about the role of bilirubin in stroke. We assessed the relation of serum bilirubin levels with clinical presentation and outcomes among patients hospitalized with ischemic stroke.METHODS: Data were collected prospectively during a 5-year period on consecutive ischemic stroke admissions to a university hospital. Serum bilirubin levels, total (Tbil) and direct (Dbil), were measured on admission. Presenting stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Functional outcome at discharge was assessed using the modified Rankin scale.RESULTS: Among 743 patients, mean age was 67.3 years and 47.5% were women. Median presenting NIHSS score was 4, and 24% had a poor (modified Rankin scale 4-6) functional outcome at discharge. Higher Dbil levels were associated with greater stroke severity (P = .001) and poorer discharge outcome (P = .034). Multivariable regression analyses showed that those with higher Dbil levels (> or =0.4 mg/dL) had significantly greater admission NIHSS scores compared with those with lower levels (< or =0.1 mg/dL) (odds ratio 2.79, 95% confidence interval 1.25-6.20, P = .012), but no independent relationship was confirmed between Dbil and discharge outcome. Although higher admission Tbil was associated with greater stroke severity in crude analyses (P = .003), no independent relationship between Tbil versus stroke severity or outcome was noted after adjusting for confounders.CONCLUSIONS: Higher Dbil level is associated with greater stroke severity but not outcome among ischemic stroke patients, possibly reflecting the intensity of initial oxidative stress. Further study into the underlying pathophysiology of this relationship is needed.