生理范围内血清胆红素水平变化与脑卒中后认知障碍相关性的临床研究  

Clinical Study on the Relationship of Changes in Serum Bilirubin Levels in Physiologic Concentration with Post-Stroke Cognitive Impairment

作　　者：王潇 郭苏芹 胡建林 雷春华 朱云飞 钟萍 WANG Xiao;GUO Suqin;HU Jianlin;LEI Chunhua;ZHU Yunfei;ZHONG Ping(Department of Rehabilitation Medicine,Wuxi No.2 Chinese Medicine Hospital,Wuxi,Jiangsu 214121,China;Department of Laboratory Medicine,Wuxi No.2 Chinese Medicine Hospital,Wuxi,Jiangsu 214121,China;Department of Neurology,Yangpu District Shidong Hospital in Shanghai City,Shanghai 200438,China)

机构地区：[1]无锡市第二中医医院康复医学科,江苏无锡214121 [2]无锡市第二中医医院检验科,江苏无锡214121 [3]上海市杨浦区市东医院神经内科,上海200438

出　　处：《中国医药指南》2025年第4期12-16,共5页Guide of China Medicine

基　　金：无锡市卫生健康委科研项目(Q202113)。

摘　　要：目的探讨生理范围内血清胆红素水平变化与脑卒中后认知障碍(PSCI)的相关性。方法前瞻性纳入2021年7月至2024年3月在无锡市第二中医医院住院的389例脑梗死患者,运用蒙特利尔认知评估(MoCA)量表和简易智能状态(MMSE)量表进行认知功能评估,检测基线和发病3个月时血清胆红素水平。将胆红素分为低水平组和高水平组,并根据基线和随访3个月变化分为4组:稳定低水平组(SLG)、随访后水平降低组(RLG)、随访后水平升高组(RHG)、稳定高水平组(SHG)。采用Logistic回归分析评估基线至随访3个月胆红素水平变化与PSCI的关系。结果纳入患者346例,其中有20例在病程3个月发生PSCI,有46例在病程3~6个月发生PSCI(χ^(2)=13.151,P<0.05)。随访3个月时,PSCI组胆红素水平降低,无认知障碍组(NCI)胆红素水平升高,且PSCI组胆红素水平低于NCI组(均P<0.05)。多因素Logistic回归分析显示,血清总胆红素、直接胆红素、间接胆红素SHG组患者发生PSCI的风险分别是SLG组的0.286(OR 0.286,95%CI 0.097~0.844,P=0.023)、0.337(OR 0.337,95%CI 0.143~0.793,P=0.013)和0.245(OR 0.245,95%CI 0.090~0.668,P=0.006)倍。结论生理范围内血清胆红素稳定高水平与PSCI发生风险降低存在相关性,可能是PSCI的独立保护因素之一。Objective To investigate the correlation between changes in serum bilirubin levels in physiologic concentration and post-stroke cognitive impairment(PSCI).Methods We recruited 389 cases cerebral infarction patients at Wuxi No.2 Chinese Medicine Hospital from July 2021 to March 2024 prospectively.Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)were used to evaluate cognitive function in patients with ischemic stroke.Serum bilirubin levels were detected at baseline and 3 months after stroke onset.Participants were defined as low or high bilirubin group for direct bilirubin(DBIL),indirect bilirubin(IBIL)and total bilirubin(TBIL),respectively.We defined 4 categories according to bilirubin 3-month change between baseline and follow-up:stable low-level group(SLG),remittent low-level group(RLG),remittent high-level group(RHG),stable high-level group(SHG).Logistic regression analysis was used to evaluate the relationship between changes in serum bilirubin levels from baseline to 3 months of follow-up and PSCI.Results A total of 346 ischemic stroke patients were screened.There were 20 patients with PSCI within 3 months of ischemic stroke,46 patients from 3 to 6 months post-stroke(χ^(2)=13.151,P<0.05).At 3 months of post-stroke follow-up,the bilirubin levels in the PSCI group were decreased,while in the no cognitive impairment(NCI)group were increased,and the bilirubin levels in the PSCI group were lower than that in the NCI group(P<0.05).Multivariate logistic regression analysis showed that the risks of PSCI in the SHG group patients of serum total bilirubin,serum direct bilirubin,and serum indirect bilirubin were 0.286(OR 0.286,95%CI 0.097-0.844,P=0.023)times,0.337(OR 0.337,95%CI 0.143-0.793,P=0.013)times,and 0.245(OR 0.245,95%CI 0.090-0.668,P=0.006)times,respectively,compared with the SLG group.Conclusions Within the physiological range,stable high-levels of serum bilirubin are correlated with a reduced risk of PSCI,which may be one of the independent protective factors for PSCI.

关 键 词：胆红素水平变化 脑卒中后认知障碍 脑梗死 前瞻性研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]