The inverse association of incident cardiovascular disease with plasma bilirubin is unaffected by adiponectin

Objective

Bilirubin may protect against atherosclerotic cardiovascular disease (CVD). The heme oxygenase pathway is crucial for bilirubin generation, and is stimulated by adiponectin. We tested the relationship of plasma bilirubin with adiponectin, and determined whether the association of incident CVD with bilirubin is modified by adiponectin.

Methods

A community-based prospective nested case–control study (PREVEND cohort) was carried out in 87 non-diabetic men who developed a first cardiovascular event (cases) and 94 controls during a median follow-up of 6.1 (2.8–10.6) years.

Results

In all subjects combined, bilirubin was positively related to adiponectin (r = 0.205, P = 0.006). Age-adjusted incident CVD was inversely associated with bilirubin (hazard ratio (HR): 0.80 (95% CI 0.65–0.99), P = 0.048), independently of adiponectin (HR: 0.78 (95% CI 0.63–0.97), P = 0.027). Adiponectin did not modify the association of CVD with bilirubin (interaction term: P = 0.65). After additional adjustment for CVD risk factors, neither the association of incident CVD with bilirubin nor with adiponectin remained significant (P > 0.20 for both), and there was again no interaction between bilirubin and adiponectin on CVD risk (P = 0.67).

Conclusion

Bilirubin is related to adiponectin, but the association of bilirubin with CVD risk is largely unaffected by adiponectin.     

严重高胆红素血症新生儿急性胆红素脑病危险因素分析

目的 探讨严重高胆红素血症新生儿急性胆红素脑病（ABE）发生的危险因素。方法选择本院2010年1月至2012年12月诊治的胎龄≥35周、血清胆红素（TSB）峰值〉425μmol/L且资料完整、进行了头颅核磁共振及脑干听觉诱发电位检查的患儿,根据是否符合ABE的诊断标准分为病例组和对照组,对一般资料、母孕期情况、合并症、围生期缺氧、黄疸的发生发展过程及实验室指标共22项临床因素进行单因素分析,对其中13项进行多因素Logistic回归分析。结果病例组43例,对照组30例,单因素分析显示,病例组出生后体重下降程度、TSB峰值、平均每日胆红素上升值及B/A值均高于对照组,差异有统计学意义（P〈0.05）;多因素分析提示,严重黄疸诊断日龄、围生期缺氧史及酸中毒与ABE的发生相关,OR（95%可信区间）分别为0.545（0.413~0.962）、36.589（1.114~1202.032）、7.963（1.294~49.010）,P均〈0.05。结论 在严重高胆红素血症新生儿中,严重黄疸诊断日龄越小,曾有围生期缺氧史和（或）伴有酸中毒者,ABE发生风险越高;而母乳喂养、出生后体重下降多、存在母子血型不合溶血、葡萄糖-6-磷酸脱氢酶缺陷则可能是严重高胆红素血症的原因。加强黄疸的监测、对严重高胆红素血症患儿积极纠正酸中毒,可能有助于预防胆红素脑病。     

Reversibility of acute intermediate phase bilirubin encephalopathy

Aim:  To show the potential for reversing acute intermediate to advanced phase bilirubin encephalopathy.
Methods:  Case studies.
Results:  Six extremely jaundiced infants had symptoms of intermediate to advanced phase acute bilirubin encephalopathy. The infants were treated aggressively. Two patients had brain magnetic resonance imaging showing increased signals in the globus pallidus. On follow-up, all infants are neurologically normal.
Conclusions:  Intermediate-to-advanced stage acute bilirubin encephalopathy may occasionally be reversible. These cases provide a strong argument in favour of rapid and aggressive intervention in infants presenting with extreme jaundice and neurological symptoms.     

Excessively high bilirubin and exchange transfusion in very low birth weight infants

Aim: To evaluate the performance of exchange transfusion in very low birth weight (VLBW) infants with excessively high serum bilirubin levels. Methods: A population‐based observational study using data collected by the Israel National VLBW Infant Database. The study sample comprised 13 499 infants. Two definitions of excessively high‐peak bilirubin levels that might be considered as threshold levels for performance of exchange transfusion were used. First, a bilirubin level of ≥15 mg/dL for all infants (PSB‐15), and second, incremental bilirubin levels ranging from 12 to 17 mg/dL according to gestational age (PSB‐GA). Results: Four hundreds sixty‐eight (3.5%) and 1035 infants (7.7%) infants in the PSB‐15 and in the PSB‐GA groups respectively had peak serum bilirubin levels above thresholds for exchange transfusion. Exchange transfusions were performed in 66 (14.1%) of these infants in the PSB‐15 group and 91 (8.8%) in the PSB‐GA group. Using logistic regression analysis, peak serum bilirubin was found as an independent factor for performing exchange transfusion. Conclusion: Exchange transfusion was performed in only 9–14% of VLBW infants with excessively high bilirubin levels. We speculate that this may be a result of an absence of definitive guidelines or the possible belief that the risks of exchange transfusion outweigh the potential risk of bilirubin‐induced neurological injuries.     

不同剂量胆红素对内毒素致大鼠急性肺损伤的保护作用

目的探讨不同剂量的胆红素对内毒素致急性肺损伤(ALI)的保护作用及其可能机制。方法将雄性Wistar大鼠(200~250 g)40只,按随机数字表法分为正常对照组、ALI动物模型组、大剂量胆红素干预组和小剂量胆红素干预组。观察肺组织形态学变化,检测肺组织肺系数(LI)、支气管肺泡灌洗液(BALF)中白细胞(WBC)计数和中性粒细胞(PMN)百分比、蛋白质含量(Pr)、肺泡通透指数(LPI);测定肺组织匀浆中超氧化物歧化酶(SOD)、脂质过氧化产物丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)含量变化。结果①ALI模型组LI、BALF中WBC计数、PMN百分比和Pr及LPI均显著高于生理盐水对照组(P均<0.01)。大剂量胆红素干预组LI,BALF中WBC计数和LPI均显著低于ALI模型组(P均<0.01),PMN百分比和Pr也明显低于ALI模型组(P均<0.05),且与生理盐水对照组差异无统计学意义。小剂量胆红素组LI、BALF中PMN百分比、Pr和LPI均显著低于ALI模型组(P均<0.05)。②ALI模型组MDA含量显著高于生理盐水对照组(P<0.01),SOD和GSH-Px水平却明显低于生理盐水对照组(P<0.01)。大剂量胆红素干预组肺匀浆中MDA含量明显低于ALI模型组(P<0.01),而肺匀浆中的SOD活性和GSH-Px含量显著高于ALI模型组(P<0.01,P<0.05)且与生理盐水对照组差异无统计学意义。小剂量胆红素干预组MDA含量明显高于正常对照组(P<0.05),而SOD活性和GSH-Px含量显著低于正常对照组(分别P<0.05、P<0.01)且与ALI模型组差异无统计学意义。结论胆红素通过其抗氧化作用对抗大鼠ALI并且存在剂量依赖性。     

长期服用缬沙坦对高血压患者动脉形态和功能的影响

目的:探讨长期服用缬沙坦对高血压患者动脉形态及功能的影响。方法:以彩色多普勒超声检测颈动脉内膜-中层厚度(IMT),测定未受干预状态下、肱动脉反应性充血时及含服硝酸甘油后颈动脉内径。按血清总胆红素(TBil)水平将89例患者分为低血清胆红素水平组(A组,n=58)和高血清胆红素水平组(B组,n=31),比较2组IMT和颈动脉内径的变化。连续服用缬沙坦36mo后检测颈动脉IMT和3种状态下的颈动脉内径,并与治疗前比较。结果:89例患者血清TBil水平均在正常范围内,A组TBil水平显著低于B组,A组IMT值显著高于B组。服用缬沙坦8wk后血压能控制在140/90mmHg以下且保持平稳。治疗36mo后,A、B组的颈动脉IMT较治疗前均显著降低。A组治疗前肱动脉反应性充血时颈动脉内径的变化率显著低于B组,治疗后均显著升高;含服硝酸甘油后颈动脉内径的变化在治疗前后无显著意义。结论:血清胆红素对动脉形态与功能具有保护作用。血管紧张素Ⅱ受体拮抗药缬沙坦在平稳降压的同时,能保护血管内皮细胞,改善血管内皮依赖性舒张功能,延缓甚至逆转IMT的进展。     

新生儿行为神经测定联合儿心量表在预测胆红素神经毒性中的价值探讨

目的探讨新生儿行为神经测定（NBNA）联合儿心量表在预测胆红素神经毒性中的价值。方法将2006年1～12月收治的足月无缺氧、窒息病史的高胆红素血症患儿76例，根据脑干听觉诱发电位（ABR）表现分成A、B、C三组，比较三组患儿治疗前、治疗后7、14d的NBNA总分及随访至1岁行儿心量表检测的发育商（DQ），分析NBNA及儿心量表与ABR的相关性。结果与A、B组比较，C组NBNA及儿心量表明显异常，可见NBNA及儿心量表与ABR的异常密切相关。结论NBNA联合儿心量表是预测胆红素神经毒性的良好指标。     

血清胆红素、尿酸、血脂水平含量与冠心病的相关性分析

目的研究血清胆红素、尿酸、血脂水平与冠心病的关系。方法应用日立7180全自动生化仪分别测定52例临床确诊的冠心病患者和42例正常人的血清胆红素、尿酸、血脂（总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白）的含量。采用病例对照的研究方法,对两组结果进行比较分析。结果冠心病组血清胆红素,HDL的水平明显低于正常对照组（P〈0.01）,CH、TG、LDL、UA的水平明显高于对照组（P〈0.01）,且男性尿酸水平明显高于女性,差异有统计学意义（P〈0.05）。结论冠心病的发病危险与胆红素、HDL呈负相关,与CH、TG、LDL、UA呈正相关。     

新生儿血清胆红素与肌酸激酶同工酶的关系

目的观察新生儿血清胆红素与肌酸激酶同工酶(CK-MB)的关系,探讨新生儿血清胆红素与心肌损害的关系。方法对40例正常新生儿、40例生理性黄疸新生儿、40例病理性黄疸新生儿的CK-MB水平进行测定并比较。结果正常组新生儿的CK-MB水平与生理性黄疸组、病理性黄疸组的比较差异均有统计学意义(P<0.01),生理性黄疸组与病理性黄疸组间差异亦有统计学意义(P<0.01)。结论高胆红素可引起心肌损害,血清CK-MB可作为胆红素对心肌细胞损伤的一个重要生化指标。