姬利++张钦军

[摘要] 目的 探討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。

[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

[中图分类号] R743.33 [文献标识码] A [文章编号] 1673-7210（2017）06（b）-0127-04

Effects of early serum bilirubin level on the prognosis of patients with acute cerebral infarction

JI Li ZHANG Qinjun

Department of Neurology， Xianyang Hospital of Yan'an University， Shaanxi Province， Xianyang 712000， China

[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

急性脑梗死是指脑血供突然中断后导致的脑组织坏死。随着国内饮食水平的提高以及生活方式的改变，动脉粥样硬化源性的急性脑梗死发病率逐年升高[1]。由急性脑梗死所导致的猝死率、致残率始终居高不下，而针对如何评价风险以及改善预后依然没有有效措施。胆红素在以往观念中常常被视为肝功能的评价指标[2]，但是越来越多的证据证实，作为人体内源性两大抗氧化物之一的胆红素[3]，能够有效地清除氧自由基，抑制炎性反应和泡沫细胞的形成，胆红素水平同动脉粥样硬化的发生发展息息相关，并且与其严重程度呈反比。已有大型临床试验证实了胆红素水平同心血管事件中的脑卒中的发生有着一定的联系[4]。出血性转化（HT）是指缺血性脑卒中梗死区域内继发性出血，是脑梗死自然转归的过程之一，但是大量出血，严重地威胁着患者的生命以及预后[5]。多脏器功能障碍综合征（MODS）是同时或相继并发一个以上系统或器官的急性功能衰竭，也是威胁脑梗死患者的主要并发症之一[6]。……