血清胆红素与脑梗死患者年龄及分型的关系探讨

目的探讨动脉粥样硬化性脑梗死患者发病早期(48h内)血清胆红素水平与年龄及分型的关系。方法选取127例动脉粥样硬化性脑梗死住院患者,分为动脉粥样硬化穿支闭塞型35例,动脉-动脉脑栓塞型32例,栓子清除障碍型30例,混合型30例,行NIHSS评分,采用全自动生化分析仪测定血清胆红素水平,按照患者年龄分组并与对照组比较。结果动脉粥样硬化性脑梗死患者血清胆红素水平与对照组比较显著降低(P<0.01),不同年龄段患者血清总胆红素水平比较差异有统计学意义(P<0.05);各分型中动脉-动脉脑栓塞型脑梗死血清胆红素水平最低,其次为栓子清除障碍型、混合型,而动脉粥样硬化穿支闭塞型最高。结论动脉粥样硬化性脑梗死患者血清胆红素水平与年龄及神经功能缺损程度呈负相关,在不同病因及病理生理机制方面存在差异。     

脂肪因子visfatin与缺血性脑血管病相关性及作用机制的研究

目的 通过检测急性脑梗死患者血清visfatin水平来探讨该因子与脑梗死的相关性及发病的关系.方法 分为健康对照组(A组)和实验组(B组),根据测定的颈总动脉内膜中层厚度(IMT),B组又分为无动脉粥样硬化组(B1组)和动脉粥样硬化组(B2组),常规化验空腹血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血糖,用酶联免疫吸附试验(ELISA)法来测定各组血清visfatin水平,分析visfatin与脑梗死的相关性及发病的关系.结果 visfatin水平B组高于A组,B2组高于B1组,logistic回归分析示visfatin含量越高越容易患动脉粥样硬化.结论 visfatin可作为动脉粥样硬化的独立危险因素,高水平血清visfatin与脑梗死的发病相关.     

动脉粥样硬化性脑梗死与同型半胱氨酸、高敏C-反应蛋白的相关性分析

目的探讨和分析高敏C-反应蛋白、同型半胱氨酸与动脉粥样硬化性脑梗死的关系。方法选取114例动脉粥样硬化性脑梗死患者为试验组,同期选择年龄性别相匹配的健康体检者51例为对照组,测定血清C反应蛋白（C—reactive protein,CRP）及同型半胱氨酸（hornocysteine,HCY）水平,应用颈动脉彩色超声多普勒检查颈动脉粥样硬化斑块的大小及超声特点,同时通过测定患者颈动脉内膜中层厚度变化,常规法测定血脂指标。结果动脉粥样硬化性脑梗死患者血清高敏C反应蛋白、血浆同型半胱氨酸、甘油三酯、胆固醇、低密度脂蛋白均较对照组增高,差异有统计学意义（P〈0．05）;试验组颈动脉内膜中层增厚及2级以上斑块发生的例数多于对照组,差异有统计学意义（P〈0．05）。结论血清CRP及血浆HCY水平增高对反映动脉粥样硬化性脑梗死病变有显著临床意义。     

不同TOAST分型青年脑梗死与高同型半胱氨酸血症的相关性

目的分析不同TOAST分型青年脑梗死与高同型半胱氨酸血症的相关性,为临床病因诊断提供依据。方法选取本院近3a收治的青年脑梗死患者为研究组,另选取同期在我院体检的健康体检者136例为对照组,按TOAST分型对136例青年脑梗死患者进行分组,采用循环酶法技术测定血浆Hcy水平,使用NIHSS量表评分。结果同对照组相比,青年脑梗死患者血清Hcy水平显著升高(P0.05),在TOAST分型中LAA型血清Hcy水平和NIHSS评分与其他4个亚型比较差异有统计学意义(P0.05),其他4个亚型(SAA、CA、SOE、SUE)组间比较差异无统计学意义(P0.05)。结论脑梗死病因常与动脉粥样硬化有关,LAA型发病后病情程度往往较其他亚型重,应重视早期干预和治疗。     

动脉粥样硬化性脑梗死与胰岛素抵抗的相关性研究

目的探讨胰岛素抵抗与动脉粥样硬化性脑梗死的关系。方法选取动脉粥样硬化性脑梗死患者76例,分为神经功能缺损轻型组和中重型组,健康对照者48例;各组分别检测空腹血糖、空腹血清胰岛素、血脂、尿酸,计算胰岛素敏感指数,采用SPSS软件进行统计学分析。结果动脉粥样硬化性脑梗死组空腹血糖、空腹血清胰岛素、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、胰岛素敏感指数与对照组比较差异均有统计学意义(P<0.05);动脉粥样硬化性脑梗死神经功能缺损,中重型组空腹血糖、空腹血清胰岛素、胰岛素敏感指数与轻型组比较差异均有统计学意义(P<0.05)。结论动脉粥样硬化性脑梗死患者存在胰岛素抵抗,胰岛素抵抗可能是动脉粥样硬化性脑梗死的危险因素;胰岛素抵抗与神经功能缺损的严重程度有关。     

急性动脉粥样硬化性脑梗死患者血清和脑脊液胱抑素C、超敏C反应蛋白及D-二聚体联合检测的临床意义

目的检测急性动脉粥样硬化性脑梗死患者急性期血清和脑脊液中胱抑素C(Cys C)、D-二聚体(D-D)、超敏C反应蛋白(hs-CRP)的水平,探讨Cys C、D-D、hs-CRP水平变化与急性动脉粥样硬化性脑梗死的关系,为脑血管病的预防、治疗及预后判断提供参考。方法选择2011年10月至2013年10月住院的23例急性动脉粥样硬化性脑梗死患者为脑梗死组,同期选择健康体检者28例为对照组。在全自动凝血分析仪上同时测定两组空腹血清及脑脊液D-D含量,用日立7100生化分析仪同时检测血清及脑脊液Cys C和hs-CRP含量。结果脑梗死组血清和脑脊液中hs-CRP、D-D含量均高于对照组,两组比较差异有显著统计学意义(P0.01)。脑梗死组血清中Cys C含量高于对照组,而脑脊液中Cys C含量低于对照组,两组比较差异有显著统计学意义(P0.01)。结论血清和脑脊液中hs-CRP、Cys C、D-D水平变化与急性动脉粥样硬化性脑梗死的发生、发展密切相关,对脑梗死的预防、治疗和预后均有重要临床意义。     

血清胆红素与急性脑梗死的相关性分析

目的 探讨血清胆红素水平与急性脑梗死的相关性.方法 检测70例急性脑梗死患者,70例椎基底动脉供血不足（VBI组）患者和70例健康患者的血清胆红素水平.结果 脑梗死组血清总胆红素水平、直接胆红素水平、间接胆红素水平均明显低于VBI组及健康组,差异有统计学意义（P＜0.05）.VBI组直接胆红素水平明显低于健康组,差异有统计学意义（P＜0.05）.结论 低血清胆红素水平可能是急性脑梗死发病的危险因素,而直接胆红素水平可能是更为关键的因素.     

首次脑梗死患者和正常健康者血清超敏C-反应蛋白的性别差异及其意义

目的探讨首次脑梗死患者与正常健康体检者血清超敏C-反应蛋白(hsCRP)的性别差异及意义。方法选取1 3 8例首次脑梗死患者(NIHSS评分<5分)作为脑梗死组,将其分为男性组和女性组。选取1 5 0例健康体检者作为正常组,亦分为男性组和女性组。检测各组患者血清hsCRP水平。结果脑梗死组血清hsCRP水平明显高于正常组(P<0.05)。男性脑梗死组与女性脑梗死组血清hsCRP相比较差异无统计学意义(P>0.0 5)。男性正常组与女性正常组血清hsCRP相比较,男性组高于女性组,差异有统计学意义(P<0.0 5)。男性脑梗死组与男性正常组血清hsCRP相比较差异无统计学意义(P>0.0 5)。女性脑梗死组与女性正常组血清hsCRP相比较差异有统计学意义(P<0.0 5)。结论血清hsCRP水平存在性别差异。炎症反应与女性脑梗死的发病可能有着更为密切的联系。     

高敏C反应蛋白、同型半胱氨酸、颈动脉粥样硬化斑块与进展性脑梗死的相关性分析

目的探讨血清高敏C反应蛋白、同型半胱氨酸及颈动脉粥样硬化与进展性脑梗死发生的相关性。方法应用免疫比浊法和荧光偏振免疫分析法对80例进展性脑梗死患者、98例非进展性脑梗死患者进行血清高敏C反应蛋白、同型半胱氨酸水平测定、颈动脉彩色多普勒超声检查,并与90例健康体检者作比较。结果进展性脑梗死组血清高敏C反应蛋白、同型半胱氨酸及颈动脉IMT最高,对比非进展性脑梗死组和健康对照组,差异有统计学意义(P<0.05);且进展性脑梗死组血清高敏C反应蛋白、同型半胱氨酸与颈动脉IMT呈显著正相关(r=0.6183,r=0.5862,P<0.01)。结论血清高敏C反应蛋白、同型半胱氨酸水平越高,颈动脉粥样硬化越重,容易促使梗死进展加重。     

动脉粥样硬化性脑梗死患者CXCL16 TNF-α血清水平的相关研究

目的探讨血清CXC型趋化因子配体16(CXC ligand 16,CXCL16)、肿瘤坏死因子a(tumor necrosis Factor-α,TNF-α)水平与动脉粥样硬化性脑梗死的关系。方法采用酶联免疫吸附法检测120例急性动脉粥样硬化性脑梗死患者血清CXCL16、TNF-α水平,与75例健康对照者进行比较。结果脑梗死组血清CXCL16、TNF-α水平均显著高于对照组(P0.05)。脑梗死患者病情严重程度各组的血清CXCL16水平差异有统计学意义(P0.05),而TNF-α水平差异无统计学意义(P0.05),且血清CXCL16水平与脑梗死患者病情严重程度呈等级正相关(r=0.434,P=0.000)。梗死灶大小各组和梗死部位各组的血清CXCL16、TNF-α水平差异均无统计学意义(P0.05)。联表卡方检验的相关分析得出,血清CXCL16、TNF-α水平均与发生动脉粥样硬化性脑梗死呈正相关(C=0.475,P=0.000,C=0.252;P=0.001)。脑梗死急性期血清CXCL16水平与脑梗死各危险因素及TNF-α水平之间无显著相关性(P0.05)。结论血清CXCL16、TNF-α水平在动脉粥样硬化性脑梗死急性期升高,与脑梗死的发生、发展密切相关。血清CXCL16水平可作为预测动脉粥样硬化性脑梗死发病、评估病情和判断预后的可靠生物学标记物之一。     

Elevated bilirubin after acute ischemic stroke linked to the stroke severity

Background

Our previous study demonstrated that the level of serum bilirubin after acute ischemic stroke (AIS) was correlated to the severity of stroke, also there has the evidence of hyperbilirubinemia prevalent in AIS. We aimed to identify the exact change of bilirubin in the early phase of AIS, and study if this kind of change linked to the severity of stroke.

Methods

Bilirubin and other biochemical indexes were measured in 608 AIS patients and 188 transient ischemic attack (TIA) patients which set as the control group. National Institutes of Health Stroke Scale (NIHSS) scores were assessed simultaneously with blood collection. First, the level of bilirubin and its distribution were compared between the AIS and control group. According to a cut-off point, we next analyzed the impacted factors of elevated bilirubin including the direct bilirubin (Dbil) and total bilirubin (Tbil), especially the correlation between elevated bilirubin and the severity of stroke. Finally, we compared the difference of concentration and percent of elevated bilirubin among the Oxford Community Stroke Project (OCSP) subtypes.

Results

The level of serum Dbil and Tbil was significantly higher in the AIS group than that in the TIA group. Different distribution was observed between the two groups, which manifested as the percent of low bilirubin level group was lower while high level group was higher in AIS than that in TIA, the p value were 0.043 and 0.078 in Dbil and Tbil, respectively. When the cut-off point of elevated bilirubin was selected as Dbil ≥ 6.84 μmol/L and Tbil ≥ 22.2 μmol/L, we found that both NIHSS score and relative severity of AIS were significantly associated with elevated bilirubin whenever in Dbil or Tbil, so did the OCSP subtypes. This trend was still maintained by multivariable logistic regression analysis adjust for relative influence factors. In regard of OCSP subtypes, the highest level of bilirubin was found in TACI, so did the highest rate of elevated bilirubin.

Conclusion

The serum levels of Dbil and Tbil were increased after AIS, which linked to the severity of stroke.     

脑出血患者血清胆红素和脂质变化分析

目的探讨血清胆红素和脂质水平与脑出血(CH)的关系。方法对117例CH患者的血清胆红素、胆固醇等指标进行检测,并与114例健康对照者进行比较。结果CH患者血清甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及DBIL IBIL比值较对照组显著降低(P<0.001或P<0.05),胆固醇(TC)、直接胆红素(DBIL)较对照组低,总胆红素(TBIL)、间接胆红素(IBIL)、低密度脂蛋白胆固醇(LDL-C)较对照组高,但差异无统计学意义(P>0.05)。结论血清HDL-C降低可作为CH的危险因素,TG和DBIL TBIL比值与CH关系密切。     

迟发性运动障碍患者血清尿酸及总胆红素的变化及其临床意义

目的探讨抗精神病药所致迟发性运动障碍（TD）患者体内尿酸及总胆红素水平与TD的关系：方法测定65例TD（TD组）、58例非TD（非TD组）慢性精神分裂症患者及42名正常人（对照组）血清尿酸及总胆红素浓度,并与异常不自主运动量表（AIMS）总分间的相关性采用直线相关分析。结果TD组血尿酸水平低于对照组（P〈0．01）及非TD组（P〈0．05）,TD组不同性别血尿酸水平对比差异无显著性（P〉0．05）。TD组总胆红素水平低于对照组（P〈0．05）。血尿酸及总胆红素水平与PD患者的病情轻重无明显相关性（r=-0．26及-0．31,P〉0．05）,血尿酸及总胆红素水平之间无明显相关性（r=0．33,P〉0．05）。结论血清尿酸及总胆红素水平与TD的发生有一定的关系。     

胆红素和脂质对脑卒中发病影响的差异性探讨

目的探讨血清胆红素和脂质及其综合指数与脑出血(CH)、短暂性脑缺血发作(TIA)及脑梗死(CI)的关系。方法对128例CH、108例TIA及104例CI急性期患者血清胆红素、胆固醇等指标进行检测,并进行对比分析。结果CI组年龄显著高于CH组(P<0.05)。TIA、CI组患者血清总胆红素(TBIL)、间接胆红素(IBIL)、高密度脂蛋白胆固醇(HDL-C)显著低于CH组(P<0.05或P<0.01),血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(n-HDL-C)水平及LDL-C/HDL-C、TC/HDL-CTG/HDL-C比值显著高于CH组(P<0.05或P<0.01);CI组患者血清直接胆红素(DBIL)/IBIL比值显著高于CH组(P<0.01),血清IBIL、HDL-C水平显著低于TIA组(P<0.05),血清LDL-C、n-HDL-C水平及LDL-C/HDL-C、TC/HDL-C比值显著高于TIA组(P<0.05或P<0.01),各组间其它指标间差异无统计学意义(P>0.05)。结论血清胆红素和脂质及其综合指数不同程度的变化与脑卒中关系密切。     

血管性痴呆患者血清尿酸及胆红素水平与认知功能损伤之间的关系

目的评价血管性痴呆患者血清尿酸及胆红素水平与认知功能损伤之间的关系。方法选取2015-01—2018-12在郑州大学第五附属医院神经内科住院治疗的血管性痴呆患者197例,同时,选取95名健康老年人作为对照组,收集2组患者一般资料,对2组患者肝功能、肾功能及血脂水平进行检测,利用量表对2组患者神经心理功能进行测验,比较2组患者血清尿酸和胆红素水平的变化,并研究其与神经心理功能评分的相关性。结果血管性痴呆组患者简易智力状态检查量表(MMSE评分)、剑桥老年认知检查表-中国修订版(CAMCOG-C)评分和画钟试验(CDT)评分均低于对照组,而日常生活能力(ADL)和临床痴呆评定量表(CDR)评分均高于对照组,差异均具有统计学意义(P<0.05);血管性痴呆组患者血清总胆红素、直接胆红素和间接胆红素水平均低于对照组,而尿酸水平高于对照组,差异均具有统计学意义(P<0.05);Pearson相关分析显示,血清尿酸水平与MMSE评分、CAMCOG-C评分和CDT评分均呈负相关(r=-0.217,-0.196和-0.264,均P<0.05),而与ADL评分呈正相关(r=0.302,P<0.05),总胆红素水平与CAMCOG-C评分和CDT评分均呈负相关(r=-0.167和-0.205,均P<0.05),与ADL评分呈正相关(r=0.215,P<0.05);Logistic回归分析显示,MMSE评分与患者教育年限、高血压史及尿酸水平相关(P<0.05)。结论血管性痴呆患者血清尿酸水平升高,且与患者认知功能评分呈负相关,而与患者日常生活能力评分呈正相关;总胆红素水平降低,且与患者认知功能评分呈负相关,而与日常患者生活能力评分呈正相关。高尿酸水平可能与血管性痴呆的发生有关,为血管性痴呆发生的独立危险因素之一。     

The effects of carbamazepine, valproic acid and phenobarbital on the oxidative and antioxidative balance in epileptic children

BACKGROUND: Oxidative stress has been related in a wide variety of ways with nervous tissue. We studied the effect of antiepileptic monotherapy on serum level of total antioxidant capacity, lipid hydroperoxide, total peroxide, oxidative stress index, and individual serum antioxidants such as albumin, bilirubin and uric acid. PATIENTS AND METHODS: We studied 122 subjects including healthy controls, untreated epileptic patients and epileptic patients treated with valproic acid, carbamazepine or phenobarbital. Serum total antioxidant capacity was measured as an index of antioxidants, and total peroxide was measured as index of oxidative stress. The serum concentrations of uric acid, albumin, bilirubin and lipid hydroperoxide were monitored simultaneously. RESULTS: We found that serum total antioxidant capacity levels were significantly decreased in the untreated group compared with the controls. Serum total peroxide levels were markedly increased in the untreated and carbamazepine-treated groups compared to in the controls; and lipid hydroperoxide and oxidative stress index levels were significantly higher in the phenobarbital-treated group than in the controls. Uric acid concentrations were significantly lower in the valproic-acid-treated group than in the untreated group, and total bilirubin concentrations were higher in the untreated group than in the controls. CONCLUSION: Epileptic children exposed to oxidative stress and conventional antiepileptic drugs change the oxidative/antioxidative balance. The serum oxidant and antioxidant status of epileptic children with valproic acid monotherapy are better regulated compared with children with carbamazepine and phenobarbital monotherapy.     

Antioxidant status of bilirubin and uric acid in patients with myasthenia gravis

Oxidative stress and changes in antioxidant status have been implicated in the pathogenesis of inflammatory and autoimmune diseases, and free radicals can cause considerable damage to the acetylcholine receptors. 388 individuals, including 97 patients with myasthenia gravis (MG), 135 patients with multiple sclerosis (MS) and 156 healthy controls, were assessed for serum levels of bilirubin and uric acid (UA), in order to determine the levels of these natural antioxidants in the serum. We found that serum UA levels in patients with MG were significantly lower (266.03 ± 93.09 μmol/l) compared with those of the healthy control group (338.87 ± 107.10 μmol/l, p = 0.001). However, there was no significant difference of serum UA levels between patients with MG and those with MS (p = 0.071). We also found that serum levels of total, direct and indirect bilirubin in patients with MG were significantly lower, compared with those in the healthy control group, whether male or female. From this study, we conclude that serum levels of bilirubin and UA are lower in MG patients.     

脑干听觉诱发电位在新生儿黄疸患儿中的应用

目的通过脑干听觉诱发电位(BAEP)检测,研究血清胆红素水平对新生儿黄疸患儿听力及脑干功能影响,及早产与足月黄疸患儿BAEP变化。方法297例新生儿黄疸患儿按血清胆红素(SB)水平分为5组,比较各组新生儿BAEP异常率。297例新生儿黄疸患儿按足月与早产分为2组,比较2组新生儿BAEP异常率。结果各组患儿BAEP异常率随血清胆红素水平增高而增高(P<0.01),早产儿BAEP异常率显著高于足月儿(P<0.01)。结论新生儿黄疸患儿血清胆红素水平越高,对BAEP影响越大,血清胆红素对早产儿影响更大。对新生儿进行BAEP检测,能及早发现听力及脑干功能异常,有利于早期干预。     

血清胆红素水平与颈动脉粥样硬化斑块相关性分析

目的 探讨血清总胆红素（total bilirubin,TBIL）水平与颈动脉粥样硬化（carotid atherosclerosis,CAS）斑块之间的相关性。方法 选取2009年9～10月开滦集团公司在职高级管理人员475例进行健康体检,测定血清TBIL水平,同时用彩色多普勒超声诊断仪进行颈部血管超声检测,根据颈动脉粥样硬化斑块的有无分为颈动脉粥样硬化斑块组（n=111）和无颈动脉粥样硬化斑块组（对照组）（n=364）。观察两组间血清TBIL水平是否具有差异;同时将血清TBIL水平按四分位数分为四组,分析颈动脉粥样硬化斑块与血清TBIL水平之间的关系。结果 ①颈动脉粥样硬化斑块组血清TBIL水平低于对照组,差别有统计学意义（12.61±5.17 μmol/L vs 13.83±5.31 μmol/L,P =0.033）。②不同血清TBIL水平者的颈动脉粥样硬化斑块检出率没有达到统计学差异,但随着血清TBIL水平的升高,颈动脉粥样硬化斑块检出率呈现逐渐减低趋势。③血清TBIL水平位于最高四分位者发生颈动脉粥样硬化斑块的风险显著低于血清TBIL水平位于最低四分位者［优势比（odds ratio,OR）为0.43,95%可信区间（confidence interval,CI）在0.23～0.81之间］。④校正其他影响因素后,TBIL仍为颈动脉粥样硬化斑块形成的保护性因素。结论 TBIL水平与颈动脉粥样硬化斑块的发生有一定相关性,高水平TBIL对颈动脉粥样硬化斑块形成有一定的保护作用。     

Low antioxidant status of serum uric acid,bilirubin and albumin in patients with neuromyelitis optica

Background: Oxidative stress plays a central role in neuropathology of multiple sclerosis (MS). The patients with MS have low antioxidant status. Antioxidant therapy may represent an attractive treatment of MS. However, the relationship between neuromyelitis optica (NMO), a distinct nosologic entity or a form of MS, and antioxidant status has not fully been investigated. Objectives: To investigate the correlation between NMO and serum antioxidant status of uric acid (UA), bilirubin and albumin. Methods: The serum levels of antioxidant molecules UA, bilirubin (Tbil and Ibil) and albumin were measured in 236 individuals comprising healthy subjects and patients with NMO or MS. Results: We found that serum levels of UA, Tbil, Ibil and albumin in patients with NMO were significantly lower than those in healthy control group. Moreover, these results were also observed when the male and female cohorts were investigated separately. Likewise, the serum levels of UA, Tbil, Ibil and albumin in patients with NMO were also lower than those of patients with MS. In all groups, women had lower serum UA, Tbil, Ibil and albumin levels than men. In UA groups, women had significantly lower serum UA levels than men. Conclusion: We concluded that there were reducing serum levels of UA, bilirubin and albumin in patients with NMO. The study showed patients with NMO had low antioxidant status. As a replacement therapy to patients, administration of albumin, bilirubin and UA or theirs precursors, such as inosine of UA precursor, may be beneficial to the patients with NMO.