rt-PA静脉溶栓脑梗死患者治疗前血清胆红素、尿酸水平与早期神经功能改善情况及预后的关系

发布时间：2019-05-30 10:51

【摘要】：目的分析行重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的急性脑梗死患者治疗前血清胆红素、尿酸水平与早期神经功能改善情况及预后的关系。方法 rt-PA溶栓治疗的脑梗死患者115例,根据溶栓治疗5天后NIHSS评分较溶栓前的差值(ΔNIHSS)分为神经功能改善良好组(ΔNIHSS≥4分)32例和神经功能改善不良组(ΔNIHSS4分)83例。收集两组患者基础资料及血糖、血脂、胆红素、尿酸检查资料。记录溶栓后发生不良事件的患者例数(不良事件包括溶栓后有渗血或患者最终死亡)。对所有可能影响入组患者早期神经功能改善的因素进行Logistic逐步回归分析,待校正血压、血脂、肌酐等脑梗死相关因素后,进一步分析血清胆红素、尿酸水平与早期神经功能改善情况的相关性。分析血清胆红素、尿酸水平与不良事件发生情况的相关性。结果神经功能改善良好组血清胆红素、尿酸水平及溶栓前NIHSS评分均高于神经功能改善不良组,合并高血压比例、TG、LDL低于神经功能改善不良组(P均0.05)。Logistic回归分析结果显示,血清胆红素(OR为1.108,95%CI为1.015~1.210)、血清尿酸(OR为1.010,95%CI为1.003~1.016)及溶栓前NIHSS评分(OR为1.183,95%CI为1.085~1.289)与脑梗死溶栓患者早期神经功能改善情况有关。115例患者中,发生不良事件者13例、未发生不良事件者102例,发生不良事件者血清尿酸水平高于未发生不良事件者(P=0.042),两组血清胆红素水平差异无统计学意义;Logistic回归分析结果显示,尿酸与溶栓患者不良事件的发生呈不显著负相关(OR=0.992,95%CI为0.984~1.000,P=0.047)。结论 rt-PA静脉溶栓治疗的脑梗死患者治疗前血清胆红素、尿酸水平与早期神经功能改善情况有关,高胆红素及高尿酸可能有利患者的神经功能恢复,且高胆红素及高尿酸并不明显增加不良预后的发生率。
[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.
【作者单位】：上海交通大学附属第六人民医院;
【基金】：上海市科委生物医药重大项目(14401970303)
【分类号】：R743.3

【相似文献】