Objective Toinvestigatetherelationbetweenserumneuron-specificenolase(NSE), bilirubinandcerebraldysfunction,prognosisafterlarge-arteryatheroscleroticstroke.Methods According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST)criteria,all the 73 patients with large artery atherosclerotic stroke were divided into the test group (41 cases ) and control group (32 cases ) according to the elevated or normal levels of serum NSE and total bilirubin. At the first day of their hospitalization,the National Institutes of Health Stroke Scale (NIHSS)score was conducted,their serum NSE,bilirubin (total bilirubin,direct bilirubin,indirect bilirubin)levels were detected,and were compared with the reevaluation of 7 and 14 days of their hospitalization and reexamination results. The modified Rankin Scale (mRS)was use to assess the recovery of their neurological function at day 30 after onset/admission. The prognosis of the patients was followed up at 1 year after onset/admission. The Kaplan-Meier product-limit method was used to conduct the analysis of the good outcome rate,and the good outcomes of both groups/interlayers (different bilirubin and NSE levels)were tested with Log-rank test. Results (1)The NIHSS scores,the levels of serum bilirubin and NSE at day 1,7,and 14 in the test group were significantly higher than those of a control group (all P<0. 01). The levels of serum bilirubin and NSE at day 7 and 14 were lower than those at day 1. (2)The mRS score at day 30 between the test group and the control group was singnificantly different (Z =3. 286,P =0. 001). (3)At day 1,the CT detection rate of large area cerebral infarction of the test group was significantly higher than that of the control group (56. 1%[n=23]vs. 28. 1%[n=9]). There was significant difference (χ2 =5. 712,P=0. 017). (4)The analysis result of Kaplan-Meier showed that there was no significant difference in its good outcome no matter grouped by the test or by serum NSE level stratification of the patients on admission (the accurateχ2valueswere4.063and4.685respectively,P=0.044and0.030respectively).Conclusion Early high-level serum NSE and hyperbilirubinemia can be used as the indexes of early identification of poor prognosis in patients with large-artery atherosclerotic stroke.%目的：探讨血清神经元特异性烯醇化酶（NSE）和胆红素与大动脉粥样硬化性卒中后脑功能损伤及预后的关系。方法依据急性卒中Org 10172治疗试验（TOAST）分型标准，对73例大动脉粥样硬化性卒中患者按血清NSE、胆红素水平增高与正常分为试验组41例、对照组32例。于入院第1天进行美国国立卫生研究院卒中量表（NIHSS）评分，测量血清NSE、胆红素（总胆红素、直接胆红素及间接胆红素）水平，并与患者住院第7、14天复查结果比较；于发病／入院30 d应用改良Rankin量表（mRS）评价患者神经功能恢复情况；对患者发病／入院1年的预后情况进行随访，采用Kaplan-Meier乘积限法进行良好结局率的分析，并对两组／层间（不同胆红素、NSE水平）的良好结局率进行Log-rank检验。结果（1）试验组第1、7、14天NIHSS评分、血清NSE及胆红素水平均明显高于对照组（均P＜0.01）；第7、14天的血清胆红素及NSE水平均低于第1天。（2）试验组第30天mRS评分与对照组比较差异有统计学意义（Z＝3.286，P＝0.001）。（3）第1天时，试验组大面积梗死CT检出率明显高于对照组[56.1％（23例）比28.1％（9例）]，差异有统计学意义（χ2＝5.712，P＝0.017）。（4）Kaplan-Meier分析结果显示，无论是按分组，还是按入院时患者血清NSE水平分层，其良好结局率差异均有统计学意义（精确χ2值分别为4.063、4.685，P值分别为0.044、0.030）。结论早期高水平的血清NSE、高胆红素血症能够作为早期识别预后不良的大动脉粥样硬化性卒中患者的指标。
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