Study On The Relationship Between Serum Uric Acid, Bilirubin And Cerebral Infarction

Cerebral vascular disease in our country has become one of the three diseases that threat our lives.It has very high disability, which not only affects the health status of patients, but also affects the quality of life of patients, resulting in a heavy financial burden to many families of our country. Therefore, in the treatment of cerebral vascular diseases at the same time, taking measures to reduce the population cerebrovascular disease morbidity, and actively carrying out the risk factors for cerebrovascular disease prevention are more important.The risk factors of Cerebral vascular disease can be divided into two types: non-intervention and interference .The non-intervention of the risk factors includes age, gender, race and family genetic factors, the intervention of the risk factors for cerebrovascular disease is a major target of first prevention, including smoking, drinking, obesity, hypertension, heart disease, diabetes, lipid disorders, TIA, asymptomatic carotid stenosis, oral contraceptives, Chlamydia pneumoniae infection, emotional stress, with the high-cysteamine Histidine hypercholesterolemia, metabolic syndrome, lack of physical activity, nutrition unreasonable, risk factors such as procoagulant. In addition to the above risk factors, the study find in recent years, the abnormalities of UA and blood bilirubin in the blood may have played a certain role in the pathogenesis of vascular diseases ,which becomes a research hotspot in recent years.UA is the product of purine metabolism ,which has dual characters in the body, on the one hand it plays an important role in anti-oxidation, anti-DNA damage as a reduction of material involved in redox reactions; on the other hand,it can promote the hyperplasia of vascular smooth muscle, resulting in endothelial dysfunction. The major cause of HUA is the excessive secretion of UA or the lack of renal excretion. and the latter is thought as the main reason in the study of recent years. Large number data of domestic and foreign clinical confirms that HUA may be one of the risk factors of acute cerebral infarction, therefore monitoring serum UA content can judge condition and the prognosis. Although the majority of research supports HUA is an important risk factor of ischemic stroke but there are also a small number of clinical and epidemiological studies have suggested that HUA may have neural protective effect and may reduce the morbidity of ischemic stroke and improve their prognosis.Bilirubin is separated from gall stones by Steedeler in 1864, including Dbil and Ibil, which constitute Tbil. Bilirubin molecular has a Curly structure and asymmetric crimp , and combines with albumin in plasma, then it can make C-10 of bilirubin thransform into active hydrogen atom, and therefore reacts with superoxide anion very vulnerably , which can make it have the function of radical scavenging; bilirubin contains an extension of conjugated double bond system and the activity of hydrogen atoms to prevent oxidation, and confirmed its antioxidant activity stronger than vitamin C, vitamin E,β-carotene.This shows that the participation of bilirubin in the in vivo oxidation and antioxidant balance mechanism has played an important role.studies in recent years have confirmed that, bilirubin and ischemic heart disease, such as coronary heart disease has exact negative relationship.The lower bilirubin concentrations in the normal range, the higher occurrence of coronary heart disease and myocardial infarction. There are few report about the relationship between blood UA and bilirubin and cerebral infarction and the other risk factors of cerebral infarction, such as TC, TG, LDL-C and Lp (a). Based on the above study, we'll clear the relationship between serum UA and bilirubin and cerebral infarction and the relationship between the two above and serum lipids to provide the theoretical basis and new channels for the prvention of cerebral infarction.Objective: To explore the the relationship and the clinical significance between serum UA and bilirubin levels and cerebral infarction ,this study monitors the level of serum UA, Tbil, Ibil, Dbil, TG, TC, LDL-C, HDL-C and Lp (a) about patients with cerebral infarction.In addition ,we also study the relationship between the two above and serum lipids. This study will provide the theoretical basis and new ways for the prvention of cerebral infarction.Methods: selecting randomly 435 cases of cerebral infarction from March 2004 to July 2007 in our hospital inpatient,all within 24 hours of onset of new cases, of which 263 cases are male, 172 cases are women, aged from 35 to 85 years old, average 62.4(SD11.7)years. Then selecting randomly 335 cases as control group, which are all come to our hospital for the healthy crowd. of which 201 cases are male, 134 cases are women, aged from 35 to 81 years old, average 61.1(SD10.8)years.The differences of the two groups about sex ratio and age composition are not statistically significant(P>0.05).All subjects are targeted within 24 hours after in the hospital fasting 4 ml blood and use Hitachi 7600-020 automatic biochemical analyzer, the kit is provided by Wenzhou-Machia Biotechnology Limited. We monitor the level of serum UA, Tbil, Ibil, Dbil, TG, TC, LDL-C, HDL-C and Lp (a) of the two groups , and Tbil minus Ibil is Dbil, and then do statistical analysis.Results (1)The difference of the risk factors for cerebrovascular disease about hypertension, heart disease, diabetes, smoking and drinking between the two groups is not statistically significant.(2)The level of serum UA and abnormal rate of the study Group are significantly higher then the control group, and so there were significant differences between them(P <0.01). compared with the control group ,the levels of serum Tbil, Ibil and Dbil of study Group decline significantly (P<0.01 or 0.05).(3)The TC and LDL-C of the Study Group is significantly higher than the healthy control group (P<0.01 or 0.05).However, there is no significant difference about TG, Lp(a) and HDL-C between the two groups (P>0.05).(4)There is no significant difference between male and female patients in study Group with cerebral infarction about the levels of serum UA, Tbil, Dbil and Ibil(P>0.05).(5)It has no significantly statistical difference about the levels of serum UA, Tbil, Dbil and Ibil between the previous cycle and after cycle of patients with cerebral infarction (P>0.05).(6)There is a significant negative correlation between the UA and HDL-C in patients with cerebral infarction(P<0.05),which the same as the relationship between Dbil and TC and TG (P<0.05 or 0.01).(7)Multiple regression analysis shows that, after adjusting other risk factors, the positive correlation between serum UA and cerebral infarction still exists, and has statistical significance, P<0.01, OR = 9.258,95%CL = 4.64～18.49. Tbil is negatively correlated with cerebral infarction, P<0.01, OR = 0.353,95%CL = 0.21～0.59, Ibil is also negatively correlated with cerebral infarction, P<0.01, OR = 0.473, 95%CL = 0.33～0.68. Conclusion: (1) The increasing of serum UA, TC, LDL-C and the decline of serum Tbil, Dbil and Ibil are the risk of cerebral infarction.(2) There is no relevance between TG, HDL-C, Lp(a) and cerebral infarction. (3) There is interaction between Serum UA and HDL-C, and between Dbil and TG andTC ,which jointly promotes the occurrence of cerebral infarction.