循环总胆红素水平与缺血性卒中的关联：观察性证据的系统评价和荟萃分析
Association of circulating total bilirubin level with ischemic stroke: a systemic review and meta-analysis of observational evidence.
作者信息
Zhong Ping, Wu Danhong, Ye Xiaofei, Wang Xiao, Zhou Yang, Zhu Xi, Liu Xueyuan
机构信息
Department of Neurology, Shanghai Traditional Chinese and Western Medicine Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China.
Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200000, China.
出版信息
Ann Transl Med. 2019 Jul;7(14):335. doi: 10.21037/atm.2019.06.71.
BACKGROUND
Circulating total bilirubin is a biomarker of ischemic stroke and may serve as a potential prognostic factor. It is imperative to systemically evaluate the correlation between circulating total bilirubin and risk for stroke. This systematic review and meta-analysis investigated the relationship between total serum bilirubin and risk for stroke.
METHODS
Studies published before 30 June 2017 were searched in four databases (PubMed, EMBASE, Web of Science and Cochrane Central). Additional studies were searched by reviewing references and contacting authors. Cohort, cross-sectional and case-control studies in adults that examined the association between serum total bilirubin and stroke were included irrespective of language and date of publication. The primary outcome of this study was ischemic stroke, and the secondary outcome was stroke. Abstract and full-text were reviewed by two independent reviewers, and disagreement was resolved by consulting a third reviewer. Data were extracted by two independent reviewers using a pre-designed data collection form.
RESULTS
Eleven observational studies (5 prospective and 6 cross-sectional studies) involving 131,450 subjects were included for analysis. In four studies with 83,380 subjects, the relationship between circulating total bilirubin and ischemic stroke was investigated, ischemic stroke was found in 2,496 patients, and the total odds ratio (OR) of the highest bilirubin and the lowest bilirubin for the occurrence of ischemic stroke was 0.66 (95% CI: 0.58-0.74). Eleven studies with 131,450 subjects explored the correlation between bilirubin and stroke, stroke was reported in 5,060 patients, and the total OR of the highest bilirubin and the lowest bilirubin for the occurrence of stroke was 0.73 (95% CI: 0.68-0.79). A stratified analysis based on the gender showed that the total bilirubin level in males correlated with ischemic stroke or stroke, which was not noted in females.
CONCLUSIONS
The available studies support an inverse association between circulating total bilirubin and risk for ischemic stroke and stroke in males. Prospective studies with large sample size are needed to establish the role of circulating bilirubin in the prevention of stroke.
背景
循环总胆红素是缺血性卒中的生物标志物，可能作为潜在的预后因素。系统评估循环总胆红素与卒中风险之间的相关性至关重要。本系统评价和荟萃分析研究了血清总胆红素与卒中风险之间的关系。
方法
检索了2017年6月30日前在四个数据库（PubMed、EMBASE、科学引文索引和考克兰系统评价）中发表的研究。通过查阅参考文献和联系作者检索其他研究。纳入了在成年人中检验血清总胆红素与卒中之间关联的队列研究、横断面研究和病例对照研究，不考虑语言和发表日期。本研究的主要结局是缺血性卒中，次要结局是卒中。由两名独立的审阅者对摘要和全文进行审阅，如有分歧则通过咨询第三位审阅者解决。由两名独立的审阅者使用预先设计的数据收集表提取数据。
结果
纳入11项观察性研究（5项前瞻性研究和6项横断面研究），共131450名受试者进行分析。在4项共83380名受试者的研究中，研究了循环总胆红素与缺血性卒中之间的关系，2496例患者发生缺血性卒中，最高胆红素组与最低胆红素组发生缺血性卒中的总比值比（OR）为0.66（95%CI：0.58-0.74）。11项共131450名受试者的研究探讨了胆红素与卒中之间的相关性，5060例患者报告发生卒中，最高胆红素组与最低胆红素组发生卒中的总OR为0.73（95%CI：0.68-0.79）。基于性别的分层分析显示，男性的总胆红素水平与缺血性卒中和卒中相关，而女性未观察到这种相关性。
结论
现有研究支持循环总胆红素与男性缺血性卒中和卒中风险呈负相关。需要进行大样本量的前瞻性研究来确定循环胆红素在预防卒中中的作用。
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