【摘要】：目的分析行重組組織型纖溶酶原激活劑(rt-PA)靜脈溶栓治療的急性腦梗死患者治療前血清膽紅素、尿酸水平與早期神經(jīng)功能改善情況及預后的關(guān)系。方法 rt-PA溶栓治療的腦梗死患者115例,根據(jù)溶栓治療5天后NIHSS評分較溶栓前的差值(ΔNIHSS)分為神經(jīng)功能改善良好組(ΔNIHSS≥4分)32例和神經(jīng)功能改善不良組(ΔNIHSS4分)83例。收集兩組患者基礎(chǔ)資料及血糖、血脂、膽紅素、尿酸檢查資料。記錄溶栓后發(fā)生不良事件的患者例數(shù)(不良事件包括溶栓后有滲血或患者最終死亡)。對所有可能影響入組患者早期神經(jīng)功能改善的因素進行Logistic逐步回歸分析,待校正血壓、血脂、肌酐等腦梗死相關(guān)因素后,進一步分析血清膽紅素、尿酸水平與早期神經(jīng)功能改善情況的相關(guān)性。分析血清膽紅素、尿酸水平與不良事件發(fā)生情況的相關(guān)性。結(jié)果神經(jīng)功能改善良好組血清膽紅素、尿酸水平及溶栓前NIHSS評分均高于神經(jīng)功能改善不良組,合并高血壓比例、TG、LDL低于神經(jīng)功能改善不良組(P均0.05)。Logistic回歸分析結(jié)果顯示,血清膽紅素(OR為1.108,95%CI為1.015~1.210)、血清尿酸(OR為1.010,95%CI為1.003~1.016)及溶栓前NIHSS評分(OR為1.183,95%CI為1.085~1.289)與腦梗死溶栓患者早期神經(jīng)功能改善情況有關(guān)。115例患者中,發(fā)生不良事件者13例、未發(fā)生不良事件者102例,發(fā)生不良事件者血清尿酸水平高于未發(fā)生不良事件者(P=0.042),兩組血清膽紅素水平差異無統(tǒng)計學意義;Logistic回歸分析結(jié)果顯示,尿酸與溶栓患者不良事件的發(fā)生呈不顯著負相關(guān)(OR=0.992,95%CI為0.984~1.000,P=0.047)。結(jié)論 rt-PA靜脈溶栓治療的腦梗死患者治療前血清膽紅素、尿酸水平與早期神經(jīng)功能改善情況有關(guān),高膽紅素及高尿酸可能有利患者的神經(jīng)功能恢復,且高膽紅素及高尿酸并不明顯增加不良預后的發(fā)生率。
[Abstract]:Objective To study the relationship between serum bilirubin, uric acid level and early neurological function improvement and prognosis in patients with acute cerebral infarction treated with recombinant tissue-type plasminogen activator (rt-PA) in patients with acute cerebral infarction. Methods 115 patients with cerebral infarction treated with rt-PA were divided into three groups: NNIHSS (4-point) and neurological functional improvement (NNIHSS4). The basic data of the two groups and blood glucose, blood lipid, bilirubin and uric acid were collected. Number of patients with adverse events after thrombolysis (adverse events including bleeding after thrombolysis or eventual death of the patient). Logistic regression analysis was performed on all factors that could affect the improvement of the neurological function of the enrolled patients, and the correlation between serum bilirubin, uric acid level and the improvement of early neurological function was further analyzed after the related factors of cerebral infarction such as blood pressure, blood fat, and myocardiac muscle were corrected. The relationship between serum bilirubin, uric acid level and the occurrence of adverse events was analyzed. Results The levels of serum bilirubin, uric acid and NIHSS in the group with good neurological function were higher than that of the neurological improvement group, and the proportion of hypertension, TG and LDL were lower than that of the neurological functional improvement group (P <0.05). The results of logistic regression showed that serum bilirubin (OR was 1.108,95% CI was 1.015-1.210), serum uric acid (OR was 1.010,95% CI was 1.003-1.016), and NIHSS score (OR was 1.183,95% CI was 1.085-1.289) before and after thrombolysis. The serum uric acid level in the patients with adverse events was higher than that of the non-adverse event (P = 0.042). The results of logistic regression analysis showed that the serum uric acid level in the patients with adverse events was higher than that of the non-adverse event (P = 0.042). There was no significant negative correlation between uric acid and the occurrence of adverse events in patients with thrombolytic therapy (OR = 0.992,95% CI: 0.984-1.000, P = 0.047). Conclusion The level of serum bilirubin and uric acid in patients with cerebral infarction treated with rt-PA intravenous thrombolysis is related to the improvement of early neurological function, high bilirubin and hyperuricemia may be beneficial to the recovery of the neurological function, and the high bilirubin and hyperuricemia do not significantly increase the incidence of adverse prognosis.
【作者單位】： 上海交通大學附屬第六人民醫(yī)院;
【基金】：上海市科委生物醫(yī)藥重大項目(14401970303)
【分類號】：R743.3

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