Relationship Between Serum Bilirubin And The Severity Of White Matter Hyperintensity In Patients With Acute Cerebral Infarction

Background and PurposeCerebral small vessel disease(CSVD)represents a group of lesions that affect the perforator arteries,small arteries(40-200μm in diameter),capillaries and small veins,and they have similar pathologic processes.Cerebrovascular disease includes lacunar infarct,lacunae,white matter hyperintensity,enlarged perivascular space,microbleeds,microvascular infarction and brain atrophy,the disease burden accounts for one fifth of global cerebrovascular disease.Cerebral small blood vessel disease is very common and leads to a large number of cognitive decline,mental disorders and physical disability.white matter hyperintensity shows low-density signal on CT,high or low on T1,high signal on T2,and high signal on T2 Flair,and often distributes symmetrically distribution.Bilirubin,the final product of hemoglobin catabolism,is the main endogenous lipophilic antioxidant,which plays a cytoprotective effect in a variety of tissues and organs.Studies of multivariate analysis in the adjustment of traditional cerebrovascular disease risk factors have shown that bilirubin is a protective factor of white matter hyperintensity in female patients,but not significant in men.Zhou X has found that bilirubin is a protection factors for subcortical infarction and white matter hyperintensity.MethodsThis study was based on the prospective inclusion of acute ischemic stroke in the First Affiliated Hospital of Zhengzhou University,and included in the standard patients with acute ischemic stroke from January 2013 to April 2016,Related laboratory tests and clinical data.According to the Fazekas visual scale.(P <0.05).The severity of white matter hyperintensity was divided into Periventricular White matter hyperintensities(PWMHs)and deep white matter hyperintensities(DWMHs),and Fazekas score was evaluated respectively.The sum of them was used as the evaluation index for the severity of white matter hyperintensity and analyzed by SPSS 21.0.Comparison of continuous data was analyzed by Mann-Whitney U test and classification data was analyzed by 2 tests.The total Fazekas score of 3 credits is set as the dividing point,the severity of white matter hyperintensity is divided into two classification variables(P <0.05),and then the significant single factor was processed to the multivariate logistic regression to further explore the the relationship between bilirubin and white matter hyperintensity.That P <0.05(two-way)was statistically significant.ResultsIn the present study,a total of 1805 patients with acute ischemic stroke within 14 days were included in the study based on inclusion criteria and exclusion criteria.Among them,750 cases(68.4%)were male and 347 cases(31.6%)were aged 21-92 years old.The average age was 59.39 ± 12.2 years old.There were 502 cases(45.8%)with severe white matter hyperintensity and 595(54.2%),98 patients(8.9%)with coronary heart disease,167 patients(15.2%)with hyperlipidemia,667 patients(60.8%)with hypertensive disease,254 patients(23.2%)with diabetes history,463 cases(42.3%)of smoking history,398 cases of drinking history(36.4%),and 297 cases(27.1%)of patients with previous stroke history.Serum total bilirubin levels were divided into four grades: <8.05μmol / L,8.06-10.8 μmol / L,10.81-14.1μmol / L,14.11-25 μmol / L,then at the lowest Serum bilirubin level group as a reference;and then repeated reference between the four groups.Hypertension history(P <0.001),age(p <0.001),stroke history(p <0.001),urea nitrogen(p = 0.024),total bilirubin quarter(p = 0.006),gender(P = 0.003),smoking history(p = 0.014)were statistically different;the severity of white matter hyperintensity was classified as the dependent variable,and the variables were statistically significant: the two categories of hypertension history,stroke history and gender,age,urea nitrogen were independent variables,and logistic regression analysis was performed;hypertension history OR(95% CI): 1.68(1.28,2.205),(p <0.001);age:OR(95% CI): 1.067(1.054,1.080),(p <0.001),stroke history:OR(95% CI): 1.352(1.008,1.812),(p = 0.044).The relationship between Bilirubin four categories and the severity of white matter hyperintensity were statistically significant(p = 0.006);When the total bilirubin Q1 was the referance.Q2 Compared to Q1,OR(95% CI): 0.656(0.455,0.946)(p = 0.024).Q1 Compared to Q2,OR(95% CI): 1.525(1.058,2.99)(p = 0.024);Q2 Compared to Q3,OR(95% CI): 0.523(0.362,0.755)(p = 0.001).Compared with Q1 and Q3,Q2 is the protective factor of the white matter hyperintensity.ConclusionIn patients with acute cerebral infarction,normal range of bilirubin at a particular level is the protective factor of white matter hyperintensity.that is,bilirubin quartile,compared with the first quartile.A slight increase in bilirubin has a protective effect on WMHs.