Liu Yi, Mao Xueyu, Li Qian, Liu Yang, Wu Xuechun, Chu Min, Niu Huicong, Sun Lulu, He Yu, Chang Xinyue, Guo Daoxia, Shi Mengyao, Zhang Yonghong, Zhao Jing, Zhu Zhengbao
Department of Psychiatry, Affiliated Guangji Hospital of Soochow University, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China.
J Affect Disord. 2025 Jul 1;380:340-346. doi: 10.1016/j.jad.2025.03.132. Epub 2025 Mar 25.
Bile acids are implicated in the cholesterol synthesis and lipid metabolism. We aimed to prospectively investigate the relationships between serum TBA and adverse clinical outcomes after ischemic stroke.
Serum TBA levels at baseline were measured for 6609 ischemic stroke patients admitted at Minhang Hospital from January 2018 to December 2022. The primary outcome was a composite outcome of death and major disability (modified Rankin Scale [mRS] score, 3-6) at 3 months after stroke onset, and secondary outcomes included major disability (mRS score, 3-5), death (mRS score, 6), and ordered 7-level categorical score of the mRS.
During the 3-month follow-up period, a total of 2118 (34.5 %) patients experienced primary outcome. After multivariate adjustment, the odds ratios of primary outcome for the highest versus the lowest quartile of TBA were 0.71 (95 % CI, 0.58-0.88; P = 0.001). Each SD increase of log-transformed TBA was associated with a 12 % (95 % CI, 5 %-18 %) decreased risk of the primary outcome. Multiple-adjusted spline regression model showed a linear association of serum TBA levels with the primary outcome (P for linearity = 0.005). Subgroup analyses further confirmed the inverse associations between serum TBA levels and the prognosis of ischemic stroke.
Elevated serum TBA levels were independently associated with a decreased risk of adverse outcomes at 3 months after ischemic stroke, indicating that TBA might be implicated in the development of ischemic stroke and might be a prognostic biomarker for ischemic stroke.
胆汁酸与胆固醇合成及脂质代谢有关。我们旨在前瞻性研究血清总胆汁酸（TBA）与缺血性卒中后不良临床结局之间的关系。
对2018年1月至2022年12月在闵行医院住院的6609例缺血性卒中患者测定基线血清TBA水平。主要结局是卒中发作后3个月时死亡和严重残疾的复合结局（改良Rankin量表[mRS]评分，3 - 6分），次要结局包括严重残疾（mRS评分，3 - 5分）、死亡（mRS评分，6分）以及mRS的有序7级分类评分。
在3个月的随访期内，共有2118例（34.5%）患者出现主要结局。多因素调整后，TBA最高四分位数与最低四分位数相比，主要结局的比值比为0.71（95%可信区间，0.58 - 0.88；P = 0.001）。对数转换后的TBA每增加1个标准差，主要结局风险降低12%（95%可信区间，5% - 18%）。多因素调整的样条回归模型显示血清TBA水平与主要结局呈线性关联（线性P值 = 0.005）。亚组分析进一步证实了血清TBA水平与缺血性卒中预后之间的负相关。
血清TBA水平升高与缺血性卒中后3个月不良结局风险降低独立相关，表明TBA可能参与缺血性卒中的发生发展，可能是缺血性卒中的预后生物标志物。
