Ischemic Stroke And Its TOAST Classification:A Correlation Analysis With Serum Bilirubin

Background: in recent years,stroke has become the most common cause of disability and death in our country,and it shows a trend of youth,which brings huge burden to the family and society of patients.Among them,ischemic stroke accounts for about 70%.It is urgent to explore other risk factors related to ischemic stroke,except traditional factors,to reduce their high incidence rate,high recurrence rate,high disability rate and high mortality rate.Bilirubin is generally considered as a hazardous waste of heme.However,it has been redefined as an effective endogenous antioxidant,anti-inflammatory and neuroprotective molecule.Objective: this study focused on the correlation between bilirubin levels and risk of acute ischemic stroke,carotid atherosclerotic plaques,severity of neurological impairment,TOAST subtype and gender,hoping to provide innovative insights and ideas for the clinical prevention and treatment of acute ischemic stroke.Methods: a total of 144 patients with acute ischemic stroke admitted to the second department of neurology of Shaanxi provincial people's hospital from January 2019 to December 2019 were selected as the study subjects,all of whom met the diagnostic criteria of the "Chinese guide for the diagnosis and treatment of acute ischemic stroke 2018".All patients were subjected to TOAST etiology classification,NIHSS score and neck vascular ultrasound examination.A total of 74 healthy physical examiners with matching age and gender of patients with acute ischemic stroke were randomly selected as the control group.Basic clinical information,laboratory test indicators and imaging data of all patients were collected in detail.To compare the difference of bilirubin level between the two groups,to explore the relationship between serum bilirubin and the stability of carotid atherosclerotic plaque,to explore whether there is a relationship between the severity of ischemic stroke and bilirubin level,and to explore whether there is a difference in bilirubin level between different subtypes of TOAST and different gender in patients with acute ischemic stroke.SPSS 23.0 software was used for statistical analysis of the data,and P < 0.05 indicated thatthe difference was statistically significant.Result:1.The bilirubin level of the plaque group was lower than that of the non-plaque group(P < 0.05),and the serum total bilirubin and indirect bilirubin levels of the unstable plaque group were significantly lower than that of the stable plaque group,with statistically significant differences(P < 0.05).2.Single-factor analysis showed that the history of diabetes,systolic blood pressure,diastolic blood pressure,hypertension,smoking history and other aspects of the ischemic stroke group were higher than the control group,and the serum total bilirubin levels of indirect bilirubin and direct bilirubin were lower than the control group,showing statistically significant differences(P<0.05).3.With ischemic stroke as the dependent variable,the history of diabetes mellitus,systolic blood pressure,diastolic blood pressure,hypertension,smoking history and bilirubin as independent variables in the above-mentioned univariate analysis,logistic regression analysis showed that the history of hypertension,smoking history,total bilirubin and indirect bilirubin were independent risk factors for ischemic stroke(P<0.05).4.Compared with the group with mild ischemic stroke,the levels of total bilirubin and indirect bilirubin in the group with moderate to severe ischemic stroke were significantly increased,showing a statistically significant difference(P < 0.05),The levels of total bilirubin and indirect bilirubin were positively correlated with NIHSS scores.5.The levels of total bilirubin and indirect bilirubin in male patients with ischemic stroke were lower than those in female patients,with statistically significant differences(P <0.05).6.There was no statistically significant difference in serum levels of TBIL,DBIL and IBIL among the different TOAST subtypes of acute ischemic stroke patients(P > 0.05).Conclusion:1.There was a correlation between carotid atherosclerotic plaque and serum bilirubin level.In a certain range,high bilirubin level was a protective factor for the formation of carotid atherosclerotic plaque and was positively correlated with plaque stability.2.Low serum bilirubin levels are associated with increased risk of ischemic stroke and are risk factors for ischemic stroke.3.Men with low bilirubin levels should pay more attention to the prevention of ischemic stroke.4.The serum levels of total bilirubin and indirect bilirubin in acute ischemic stroke can reflect the severity of the disease and can be used as one of the predictie indexes to reflect the degree of oxidative stress.5.There was no significant difference in the distribution of bilirubin levels among different subtypes of TOAST classification in patients with acute ischemic stroke.