血清总胆红素高水平与缺血性脑卒中发病风险降低关系的前瞻性研究

摘要

目的 通过对社区健康人群进行前瞻性随访研究,探讨血清总胆红素高水平与缺血性脑卒中发生风险降低的关系.方法 采用流行病学整群抽样方法,于2009年5月~2009年8月调查宜兴市官林镇和徐舍镇4230例35~75岁的健康人群.收集调查对象的一般人口学资料、体格检查及生化检测.排除基线有脑卒中史和心血管疾病史149例后,4081例纳入随访研究,收集随访期间缺血性卒中的发生情况.本研究研究对象随访于2014年9月开展,2016年1月结束.基线检测总胆红素水平并处于正常范围的2077例纳入分析,根据总胆红素四分位数间距将总人群按照胆红素平均水平分为4组(Q1~Q4),Cox比例风险回归模型计算胆红素升高对缺血性卒中发生的相对危险度(Hazard ratio,HR).结果 在平均5.16 y的随访中(共10717.32人年的随访),纳入分析人群共发生88例脑卒中(男性44例,女性44例).校正性别、年龄、血压、血糖等混杂因素后,与Q1组人群相比,Q3组人群发生缺血性脑卒中风险显著降低,HR和95% CI 0.57(0.30~1.07);与Q1组人群相比,Q4组人群发生缺血性脑卒中风险也显著降低,HR和95% CI 0.47(0.24~0.91);而Q2人群与Q1组人群相比缺血性脑卒中风险未见明显降低.在进一步分层分析中发现年龄超过55岁、女性不吸烟不饮酒对象中血清高胆红素水平者发生缺血性脑卒中的风险降低,且具有统计学意义.结论 高血清胆红素水平与缺血性脑卒中的发生风险降低存在相关性.%Objective To investigate the relationship between serum bilirubin levels and the risk of ischemic stroke in the township of Yixing through a prospective follow-up study. Methods 4230 healthy people aged 35~75 were strati-fied by six villages in Xushe township and Guanlin township in Yixing area and than collect the occurrence of ischemic stroke during follow-up. Baseline survey was conducted from May to August 2009.We collect the general demographic data, physical examination and biochemical examination of the subject. Excluding 149 people with a history of stroke and cardio-vascular disease,4081 people were followed-up. The 2077 people whose total bilirubin detected in the normal range were analyzed. The total population was divided into four groups based on tattoo bilirubin quartile range. The study began in September 2014 and ended in January 2016.And cox proportional risk regression model was used to calculate relative risk. Results Follow-up studies were conducted on average duration of approximately 5.16 person(total 10717.32 follow-up years). To the end of follow-up,a total of 88 people had a stroke,including 44 male people,44 women people. After sex, age,blood pressure,blood sugar and other confounding factors corrected,compared with Q1 crowd,the risk of ischemic stroke was significantly reduced in Q3 group. HR and 95% CI respectively 0.60(0.32 ~1.14). and compared with Q1 group,the risk of ischemic stroke was significantly reduced in Q4 group,HR and 95% CI respectively 0.54(0.27~1.05). But the risk of ischemic stroke wasn't go down significantly in Q2 group when compared with Q1 group. And it was found in further stratification analysis that women aged over 55 who don't smoke and don't drink the risk of ischemic stroke is re-duced in the high levels of serum bilirubin levels. Conclusion Elevated serum bilirubin levels are an independent protec-tive factor for the onset of ischemic stroke.