Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China.
Curr Neurovasc Res. 2012 May;9(2):128-32. doi: 10.2174/156720212800410876.
Elevated serum bilirubin was prevalent in the acute ischemic stroke (AIS), which was induced in response to oxidative stress and could display the intensity of oxidative stress. As more severe stroke is linked with higher level of oxidative stress, we hypothesized that bilirubin may be associated with the severity of stroke. In this study, bilirubin and other biochemical indexes were measured in 531 enrolled patients with AIS, and NIH Stroke Scale (NIHSS) scores were assessed simultaneous with blood collection. The association between bilirubin and the severity of stroke was performed by Spearman correlation analyze, and the level-risk relationship of bilirubin in different level of NIHSS score was performed through Multinomial logistic regression analysis. We performed multivariable logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) of severe stroke dichotomized as NIHSS≥8 with adjustment for other stroke risk factors, the level-risk relationship of severe stroke in different level of bilirubin was also performed through Multinomial logistic regression analysis. We found that NIHSS score was significantly positively correlated with both serum direct bilirubin (Dbil, R=0.229 and P=0.000) and total bilirubin (Tbil, R=0.224 and P=0.000), higher level of serum bilirubin linked to the higher NIHSS score with OR(95% CI) in upper level of NIHSS score group was 1.12(1.01-1.24), 1.23(1.11-1.36), 1.31(1.15-1.51) in Dbil and 1.01(0.99-1.31), 1.05(1.03-1.08), 1.07(1.03-1.11) in Tbil compared to the lowest level group. In unadjusted or adjusted logistic regression analyses, serum Dbil and Tbil still have a significant association with the severe stroke. When both the Dbil and Tbil concentrations were grouped into 4 levels, participants with higher levels of bilirubin showed higher risk with severe stroke compared with the lowest level of bilirubin, with OR(95% CI) 1.881(1.04-3.404) of Dbil in level 3 and 3.702(1.979-6.927) of Tbil, 3.352(1.572-7.147) of total bilirubin in level 4. As a conclusion, serum bilirubins were in significant correlation with severity of AIS, which may be served as useful markers to reflect the degree of illness.
血清胆红素升高在急性缺血性脑卒中（AIS）中较为常见，这是由氧化应激引起的，可反映氧化应激的强度。由于更严重的中风与更高水平的氧化应激有关，我们假设胆红素可能与中风的严重程度有关。在这项研究中，我们测量了 531 名 AIS 患者的胆红素和其他生化指标，并在采血的同时评估了 NIH 卒中量表（NIHSS）评分。通过 Spearman 相关分析评估胆红素与中风严重程度之间的关系，通过多项逻辑回归分析评估胆红素在不同 NIHSS 评分水平的风险-水平关系。我们进行了多变量逻辑回归分析，以估计 NIHSS≥8 为严重中风的比值比（OR）和 95%置信区间（CI），并通过多项逻辑回归分析评估胆红素在不同胆红素水平的严重中风的风险-水平关系。我们发现 NIHSS 评分与血清直接胆红素（Dbil，R=0.229，P=0.000）和总胆红素（Tbil，R=0.224，P=0.000）均呈显著正相关，较高的血清胆红素水平与 NIHSS 评分较高的 OR（95%CI）呈正相关在 NIHSS 评分较高的组中，Dbil 为 1.12（1.01-1.24），1.23（1.11-1.36），1.31（1.15-1.51），Tbil 为 1.01（0.99-1.31），1.05（1.03-1.08），1.07（1.03-1.11）与最低水平组相比。在未调整或调整后的逻辑回归分析中，血清 Dbil 和 Tbil 与严重中风仍有显著关联。当 Dbil 和 Tbil 浓度分为 4 个水平时，与最低胆红素水平相比，胆红素水平较高的患者发生严重中风的风险更高，Dbil 的 OR（95%CI）为 3.702（1.979-6.927），Tbil 为 3.352（1.572-7.147），总胆红素为 1.881（1.04-3.404）。总之，血清胆红素与 AIS 的严重程度呈显著相关，可作为反映疾病程度的有用标志物。
