急性缺血性脑卒中入院胆红素与出院复合结局的关联

摘要

Objective To explore the association of serum bilirubin level at the time of admission with the compos⁃ite outcome（disability or death）in discharged patients with acute ischemic stroke. Methods In a retrospective cohortstudy from June 1st 2009 to May 31st 2012, we continuously included 3151 patients with acute ischemic stroke and col⁃lected demography,lifestyle,clinical manifestations and laboratory test data. Functional outcome was measured with themodified Rankin scale (mRS) when subjects were discharged. Disability was defined as mRS≥3 and composite outcomewas defined as mRS≥3 or death. Serum bilirubin was divided into four groups according to the quartile. Multiple Coxregression analysis was used to assess the independent relation between serum bilirubin and disability death and the com⁃posite outcome. Results There were 407 disabled patients，the disability rate was 12.9%；and 104 patients were dead，the fatality rate was 3.3%.After adjusting for multiple factors, we found the risks of composite outcome with total bilirubin in the four quartile were higher than that in the first quartile, aHR and 95%CI were 1.335(1.047～1.702) respectively；The risks of composite outcome with indirect bilirubin in the four quartile were higher than that in the first quartile, aHR and 95%CI were 1.355(1.062～1.728) respectively; The risks of composite outcome with bilirubin direct in the third and the forth quartile were higher than that in the first quartile, aHR and 95% CI were11.403(1.089～1.807)and 1.431 (1.118～1.833) respectively.With the increase of total bilirubin，indirect bilirubin and direct bilirubin level，the compos⁃ite outcome of discharged patient was on the increase. Conclusions The study indicated that higher serum bilirubincould increase the risk of composite outcome in ischemic stroke patients, there was dose-response relationship ,and bili⁃rubin was a independent risk factor.%目的：探讨入院时胆红素水平与急性缺血性脑卒中患者出院复合结局（残疾或死亡）的关联。方法采用回顾性队列研究的方法，连续性纳入2009年6月1日至2012年5月31日阜新市中心医院神经内科3151例住院的急性缺血性脑卒中患者，收集人口统计学、生活方式、临床表现和实验室检验资料。出院时应用改良Rankin量表（modified Rankin scale，mRS）评分，mRS≥3分为残疾，mRS≥3或死亡为复合结局。根据入院时总胆红素、间接胆红素、直接胆红素的四分位数水平分别将研究对象分为4组，采用Cox回归分析入院时胆红素水平与急性缺血性脑卒中患者出院残疾、死亡和复合结局的关联。结果发生残疾的病例为407例，残疾发生率为12.9%，死亡104例，病死率为3.3%。经多因素调整后，发现以总胆红素第1分位数组为参比，第4分位数组发生复合结局的aHR值（95%CI）为1.335（1.047～1.702）；以间接胆红素第1分位数组为参比，第4分位数组发生复合结局的aHR值（95%CI）为1.355（1.062～1.728）；以直接胆红素第1分位数组为参比，第3、4分位数组发生复合结局的aHR值（95%CI）分别为1.403（1.089～1.807）、1.431（1.118～1.833）；并且随着总胆红素、间接胆红素和直接胆红素水平的升高，出院复合结局的发生风险也在增加（P＜0.05）。结论入院时胆红素水平的升高可增加急性缺血性脑卒中患者出院复合结局的风险、并且存在着剂量反应关系，是独立的危险因素。