高胆红素血症与脑出血相关性的研究

摘要

目的 评价高胆红素血症与脑出血(ICH)患者的临床特点的关系以及对患者预后的影响.方法 陕西省人民医院108例ICH住院患者,入院后常规检查血总胆红素、直接胆红素等生化检查,行美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(mRS)评分,并行头颅CT检查,记录临床资料如出血部位、出血量以及是否破入脑室系统等,半年后随访评估mRS.结果 根据肝功检查总胆红素和(或)直接胆红素的数值是否升高,将ICH患者分为高胆红素血症组(n=36)和正常组(n=72).高胆红素血症组ICH患者比正常组患者发生血肿破入脑室的例数明显增多(分别为52.8%和25.0%)(χ2=7.035,P<0.05).两组ICH患者的血肿位置存在差异,其中高胆红素血症组以丘脑出血最为多见,而正常组的血肿部位多位于基底核区(P<0.05).与正常组相比较,高胆红素血症组ICH患者具有较高的出血量、NIHSS和mRS评分(P>0.05).半年后随访,高胆红素血症组ICH患者的mRS评分比正常组患者高,但差异无统计学意义(P>0.05).结论 ICH伴有高胆红素血症的患者出现血肿破入脑室系统的可能性更大,且丘脑出血的患者更易发生.%Objective To evaluate the relationship between hyperbilirubinemia hyperbilirubinemia and clinical characteristics of patients with intracerebral hemorrhage (ICH) and to assess if hyperbilirubinemia play a role in the prognosis of ICH patients.Method 108 hospitalized patients with ICH admitted in Shanxi Provincial People's Hospital were included. At baseline, biochemical tests such as total bilirubin, direct bilirubin and others were taken;National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Score (mRS) were assessed; CT examination of head was ensured; clinical data included the bleeding site, bleeding volume and whether breaking into the ventricle system or not were recorded. Then mRS was reevaluated after six months follow-up.Results The ICH patients were divided into hyperbilirubinemia group (n=36) and normal group (n=72) according to total bilirubin and (or) direct bilirubin values whether were increased or not. The numbers of ICH patients of whom the hematoma ruptured into the ventricle system were significantly higher (χ2=7.035,P<0.05) in hyperbilirubinemia group (52.8%) than in normal group (25.0%). There were significant differences of hematoma location between two groups (P<0.05); hematomas were mostly located at thalamus in hyperbilirubinemia group while at basal ganglia in normal group. Bleeding volume, NIHSS and mRS scores were higher in hyperbilirubinemia group than in normal group, but the difference was not statistically significant (P>0.05). After six months of follow-up, mRS scores were higher in hyperbilirubinemia group than in normal patients, but the difference was also not statistically significant (P>0.05).Conclusion Hematomas appear more likely to break into the ventricular system in ICH patients with hyperbilirubinemia especially in thalamic hemorrhage patients.