CAJ | 학술논문

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、入院时及治疗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＜0.01).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.
목적 통과검측노년급성뇌경사환자혈청각류담홍소적변화,탐토기재차류질병중적의의. 방법 선취아원수치적발병1주지내급성뇌경사환자164례,근거년령분위년령＞60세적급성뇌경사환자85례(A조)；년령40～60세지간적급성뇌경사환자79례(B조)；선취40세급이상적건강자66례위대조조(C조),분별측정3조혈청각충담홍소수평；측정A、B량조환자기왕맥압여평균동맥압비치、입원시급치료2주후신경공능평분；수집A、B량조환자기왕위험인소(혈당、혈압、혈지급흡연、음주)병사. 결과 여C조비교,A、B량조환자혈청총담홍소、직접담홍소、간접담홍소균승고(균P＜0.01),A조승고폭도소우B조(P＜0.05)；A조맥압여평균동맥압비치0.46±0.06,고우B조0.38±0.06(t=7.70,P＜0.01)；A조위험인소개수평균질차(93.01)균고우B조(평균질차71.20)(P=0.002)；A조입원시신경공능평분(35.2±12.6)분,저우B조(44.3±7.9)분(t=5.58,P＜0.01),A조、B조치료2주후신경공능평분분별위(40.7±9.1)분、(51.3±4.1)분,A조신경공능평분균저우B조(t=9.73,P＜0.01).A조、B조각충담홍소분별여기신경공능평분진행상관성분석,결과현시상관성균무통계학의의(A조:P=0.239、0.056、0.099;B조:P=0.204、0.408、0.220). 결론 급성뇌경사시환자혈청담홍소수평승고,단노년환자유우고령급위험인소다,동맥경화교위엄중,도치기내원성항양화능력하강,종이재뇌결혈급성기담홍소수평승고폭도상대교소,대항응격적보호성작용야인차감약,담홍소수평적고저가능영향환자적예후.
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＜0.05).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＜0.01],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＜0.01].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 bilirubin level 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.