Liu Ying, Wang Jie, Zeng Wen-Zhen, Lyu Qing-Shan
Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China.
Department of Cardiology, The Central Hospital of Yongzhou, Yongzhou, Hunan, China.
J Int Med Res. 2020 Oct;48(10):300060520962347. doi: 10.1177/0300060520962347.
This study aimed to examine the relationship between total bilirubin levels and initial ischemic stroke in patients with non-valvular atrial fibrillation.
This was a retrospective study. Atrial fibrillation was diagnosed by 24-hour Holter electrocardiography and serum total bilirubin levels were divided into quintiles. Ischemic stroke was diagnosed by symptoms, signs, and a medical image examination. The multivariate Cox proportional hazards model and survival analysis were used to estimate the association of total bilirubin with initial ischemic stroke.
We studied 316 patients with non-valvular atrial fibrillation. During follow-up, there were 42 (13.29%) first ischemic strokes. After multivariate adjustment, for each 1 µmol/L increase in total bilirubin, the risk of first ischemic stroke increased by 4% (95% confidence interval [CI]: 1.01, 1.07). When using the first quintile as the reference, from the second to fifth quintiles, the risks of first ischemic stroke were 0.52 (95% CI: 0.17, 1.65), 0.23 (95% CI: 0.06, 0.87), 0.92 (95% CI: 0.32, 2.67), and 1.33 (95% CI: 1.09, 4.41), respectively. The optimal cut-off point of total bilirubin for the lowest risk of ischemic stroke was 17.0 µmol/L.
Total bilirubin levels are nonlinearly associated with initial ischemic stroke in patients with non-valvular atrial fibrillation.
本研究旨在探讨非瓣膜性心房颤动患者总胆红素水平与首次缺血性卒中之间的关系。
这是一项回顾性研究。通过24小时动态心电图诊断心房颤动，并将血清总胆红素水平分为五分位数。通过症状、体征和医学影像检查诊断缺血性卒中。使用多变量Cox比例风险模型和生存分析来估计总胆红素与首次缺血性卒中的关联。
我们研究了316例非瓣膜性心房颤动患者。在随访期间，有42例（13.29%）首次发生缺血性卒中。经过多变量调整后，总胆红素每升高1μmol/L，首次缺血性卒中的风险增加4%（95%置信区间[CI]：1.01，1.07）。以第一个五分位数为参照，从第二个到第五个五分位数，首次缺血性卒中的风险分别为0.52（95%CI：0.17，1.65）、0.23（95%CI：0.06，0.87）、0.92（95%CI：0.32，2.67）和1.33（95%CI：1.09，4.41）。缺血性卒中风险最低时总胆红素的最佳切点为17.0μmol/L。
非瓣膜性心房颤动患者的总胆红素水平与首次缺血性卒中呈非线性关联。
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