血清尿酸、胆红素水平与急性缺血性卒中患者近期转归的相关性

目的：探讨基线尿酸水平及胆红素水平与急性缺血性卒中患者短期转归的关系。方法收集缺血性卒中患者的临床资料,包括入院时血清尿酸和胆红素水平、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分、出院时或第14天时改良 Rankin 量表(modified Rankin Scale, mRS)评分(0~2分定义为转归良好,>2分定义为转归不良)。结果共纳入急性缺血性卒中患者162例,转归良好组114例,转归不良组48例。2组之间糖尿病(51．75%对75．00%；χ2=7．526,P =0．006)、既往卒中或短暂性脑缺血发作( transient ischemic attack, TIA)史(18．42%对50．00%；χ2=17．790, P <0．001)的患者构成比以及基线舒张压(87．061±12．245)mmHg 对(82．375±10．949)mmHg,1 mmHg =0．133 kPa；t =2．293,P =0．023]、高密度脂蛋白胆固醇(1．604±0．299)mmol/L 对(1．265±0．206)mmol/L； t =3．227, P =0．002]、空腹血糖(2．875±0．438)mmol/L 对(8．160±0．592)mmol/L； t =-4．761, P <0．001)]、尿酸(289．365±77．168)μmol/L 对(248．206±66．206)μmol/L； t =3．111, P =0．002]、总胆红素(14．673±2．213)μmol/L 对(10．395±2．714)μmol/L； t =3．779, P <0．001]、直接胆红素(6．036±1．392)μmol/L 对(4．956±1．379)μmol/L； t =2．088, P =0．038]、间接胆红素(8．634±2．307)μmol/L 对(5．439±1．223)μmol/L；t =4．219,P <0．001]水平存在显著差异。多变量 logistic回归分析显示,既往卒中或 TIA 史优势比(odds ratio, OR)3．751,95%可信区间(confidence interval, CI)1．395~10．091；P =0．009]和基线 NIHSS 评分(OR 2．723,95% CI 1．093~6．783；P =0．031)是缺血性卒中转归不良的独立危险因素,而尿酸(OR 0．357,95% CI 0．141~0．900；P =0．029)、高密度脂蛋白胆固醇(OR 0．262,95% CI 0．079~0．870；P =0．029)和间接胆红素(OR 0．117,95% CI 0．025~0．539；P =0．006)与转归良好独立相关。结论基线尿酸和间接胆红素水平增高是急性缺血性卒中患者转归良好的有利因素。

Associations of serum uric acid,bilirubin levels and short-term outcome in patients with acute ischemic stroke

Objective To investigate the associations of baseline serum uric acid, bilirubin levels with short-term outcome in patients with acute ischemic stroke. Methods The clinical data in successive patients with acute ischemic stroke were colected, including the serum levels of uric acid and bilirubin on admission, the National Institutes of Health Stroke Scale (NIHSS) score, and the modified Rankin scale (mRS) score at discharge or at day14 (mRS 0-2 was defined as good outcome, > 2 was defined as poor outcome). Results A total of 162 patients with ischemic stroke were enroled, including 114 in the good outcome group and 48 in the poor outcome group. There were significant differences in proportions of the patients with diabetes melitus (51. 75% vs. 75. 00% ; χ2 = 7. 526, P = 0. 006), previous history of stroke or transient ischemic attack (TIA) (18. 42% vs. 50. 00% ; χ2 = 17. 790, P = 0. 001), as wel as the baseline diastolic blood pressure (87. 061 ± 12. 245 mmHg vs. 82. 375 ± 10. 949 mmHg; t = 2. 293, P = 0. 023; 1 mmHg =0. 133 kPa), high-density lipoprotein cholesterol (1. 604 ± 0. 299 mmol/L vs. 1. 265 ± 0. 206 mmol/L; t =3. 227, P = 0. 002), fasting glucose (2. 875 ± 0. 438 mmol/L vs. 8. 160 ± 0. 592 mmol/L; t = - 4. 761, P <0. 001), uric acid (289. 365 ± 77. 168 μmol/L vs. 248. 206 ± 66. 206 μmol/L; t = 3. 111, P = 0. 002), total bilirubin (14. 673 ± 2. 213 μmol/L vs. 10. 395 ± 2. 714 μmol/L; t = 3. 779, P = 0. 001 ), direct bilirubin (6. 036 ± 1. 392 μmol/L vs. 4. 956 ± 1. 379 μmol/L; t = 2. 088, P = 0. 038), and indirect bilirubin (8. 634 ± 2. 307 μmol/L vs. 5. 439 ± 1. 223 μmol/L; t = 4. 219, P < 0. 001) levels between the 2 groups. Multivariate logistic regression analysis showed that the previous history of stroke or TIA (odds ratio OR ] 3. 751, 95% confidence interval CI ] 1. 395-10. 091; P = 0. 009) and baseline NIHSS score (OR 2. 723, 95% CI 1. 093-6. 783; P = 0. 031) were the independent risk factors for poor outcome of ischemic stroke; while uric acid (OR 0. 357, 95% CI 0. 141-0. 900; P = 0. 029), high-density lipoprotein (OR 0. 262, 95% CI 0. 079-0. 870; P = 0. 029), and indirect bilirubin (OR 0. 117, 95% CI 0. 025-0. 539; P = 0. 006) were independently correlated with good outcome. Conclusions The increased baseline uric acid and indirect bilirubin levels are the favorable factors for good outcome in patients with acute ischemic stroke.