摘要
目的通过检测老年急性脑梗死患者血清各类胆红素的变化，探讨其在此类疾病中的意义。方法选取我院收治的发病1周之内急性脑梗死患者164例，根据年龄分为年龄〉60岁的急性脑梗死患者85例（A组）；年龄40～60岁之间的急性脑梗死患者79例（B组）；选取40岁及以上的健康者66例为对照组（c组），分别测定3组血清各种胆红素水平；测定A、B两组患者既往脉压与平均动脉压比值、人院时及治疗2周后神经功能评分；搜集A、B两组患者既往危险因素（血糖、血压、血脂及吸烟、饮酒）病史。结果与C组比较，A、B两组患者血清总胆红素、直接胆红素、间接胆红素均升高（均P〈0．01），A组升高幅度小于B组（P〈0．05）；A组脉压与平均动脉压比值0．46±0．06，高于B组0．38±0．06（t=7．70，P〈0．01）；A组危险因素个数平均秩次（93．01）均高于B组（平均秩次71．20）（P=0．002）；A组入院时神经功能评分（35．2±12．6）分，低于B组（44．3±7．9）分（t＝5．58，P〈0．01），A组、B组治疗2周后神经功能评分分别为（40．7±9．1）分、（51．3±4．1）分，A组神经功能评分均低于B组（t=9．73，P〈O．01）。A组、B组各种胆红素分别与其神经功能评分进行相关性分析，结果显示相关性均无统计学意义（A组：P=0．239、0．056、0．099；B组：P=0．204、0．408、0．220）。结论急性脑梗死时患者血清胆红素水平升高，但老年患者由于高龄及危险因素多，动脉硬化较为严重，导致其内源性抗氧化能力下降，从而在脑缺血急性期胆红素水平升高幅度相对较小，对抗应激的保护性作用也因此减弱，胆红素水平的高低可能影响患者的预后。
Objective To investigate the changes of serum bilirubin level in elderly patients with acute cerebral infarction and its significance. Methods 164 hospitalized elderly patients, who suffered from acute cerebral infarction within 1 week after onset, were divided into 2 groups according to age： group A aged over 60 years（n=85） and group B aged 40 60 years（n=79） , and 66 healthy subjects aged over 40 years were collected as controls（group C）. Serum bilirubin levels in all subjects were determined. The ratio of pulse pressure over mean arterial pressure（PP/MAP） in group A and B was calculated. Nerve function scores in the three groups were detected before and after 2 weeks of treatment. Meanwhile, the data of risk factors including blood glucose, blood pressure, blood lipids, smoking and drinking in group A and B were collected. Results Compared with group C, serum total, direct, indirect bilirubin levels were increased in group A and B（both P〈0.01）, and the change was smaller in group A than in group B（P〈O. 05）. The nerve function scores was lower in group A than in group B before and after treatment [（35.2±12.6） vs. （44.3±7.9）, （40.7±9.1） vs. （51.3± 4.1）, t=5.58, 9.73, both P〈0. 013, but PP/MAP and the numbers of risk factors were higher in group A than in group B [（0.46±0.06） vs. （0.38±0.06）, 93.01 vs. 71.20, both P〈0. 013. There were no significant correlations of serum total, direct and indirect bilirubin levels with nerve function scores in group A or B（all P〉0.05）. Conclusions Serum bilirubin level is increased in patients with acute cerebral infarction, but the endogenous antioxidant capacity is decreased because of aging, multiple risk factors and more serious atherosclerosis in elderly patients, and the increment of bilirubinlevel is relatively smaller in acute cerebral ischemia, leading to the reduced protective effect against stress. Serum bilirubin level may influence the prognosis in patients with acute cerebral infarction.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2014年第2期126-128,共3页
Chinese Journal of Geriatrics
关键词
脑梗死
胆红素
Brain infarction Bilirubin
