Pineda Sandra, Bang Oh Young, Saver Jeffrey L, Starkman Sidney, Yun Susan W, Liebeskind David S, Kim Doojin, Ali Latisha K, Shah Samir H, Ovbiagele Bruce
Stroke Center and Department of Neurology, University of California at Los Angeles Medical Center, CA 90095, USA.
J Stroke Cerebrovasc Dis. 2008 May-Jun;17(3):147-52. doi: 10.1016/j.jstrokecerebrovasdis.2008.01.009.
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.
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.
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.
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.
较高水平的血清胆红素可能在氧化应激介导的疾病中具有治疗优势，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。我们评估了缺血性中风住院患者血清胆红素水平与临床表现及预后的关系。
前瞻性收集一所大学医院连续5年缺血性中风入院患者的数据。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）评估中风严重程度。出院时的功能预后采用改良Rankin量表进行评估。
743例患者中，平均年龄为67.3岁，47.5%为女性。入院时NIHSS评分中位数为4分，24%的患者出院时功能预后较差（改良Rankin量表评分4 - 6分）。较高的Dbil水平与更严重的中风严重程度相关（P = 0.001），且出院预后较差（P = 0.034）。多变量回归分析显示，与较低水平（≤0.1mg/dL）的患者相比，Dbil水平较高（≥0.4mg/dL）的患者入院时NIHSS评分显著更高（比值比2.79，95%置信区间1.25 - 6.20，P = 0.012），但未证实Dbil与出院预后之间存在独立关系。虽然在粗分析中较高的入院Tbil与更严重的中风严重程度相关（P = 0.003），但在调整混杂因素后，未发现Tbil与中风严重程度或预后之间存在独立关系。
较高的Dbil水平与缺血性中风患者更严重的中风严重程度相关，但与预后无关，这可能反映了初始氧化应激的强度。需要进一步研究这种关系的潜在病理生理学机制。
