Background: Bilirubin plays a paradoxical role in the pathological mechanism of stroke. To date, few clinical studies have investigated the effect of serum bilirubin on symptomatic intracranial atherosclerotic stenosis (sICAS). This study aims to evaluate the connection between serum bilirubin and sICAS. Methods: From September 2015 to May 2020, 1,156 sICAS patients without hepatobiliary diseases admitted to our hospital were included. Patients were distributed into none-mild (0-49%), moderate (50-69%) and severe-occlusion sICAS groups (70-100%) by the degree of artery stenosis. Moderate and severe-occlusion sICAS patients were classified into three groups by the number of stenotic arteries (single-, two- and multiple-vessel stenosis). The relationship between serum bilirubin levels and sICAS was analyzed by logistic regression analysis. Results: In univariable analyses, sICAS patients with severe and multiple atherosclerotic stenoses had lower levels of total bilirubin (Tbil), direct bilirubin (Dbil), and indirect bilirubin (Ibil). In multinomial logistic regression analyses, when compared with the highest tertile of bilirubin, lower levels of Tbil, Dbil, and Ibil showed higher risks of severe-occlusion sICAS (95% CI: 2.018-6.075 in tertile 1 for Tbil; 2.380-7.410 in tertile 1 for Dbil; 1.758-5.641 in tertile 1 for Ibil). Moreover, the logistic regression analyses showed that lower levels of Tbil, Dbil, and Ibil were related to multiple (≥3) atherosclerotic stenoses (95% CI: 2.365-5.298 in tertile 1 and 2.312-5.208 in tertile 2 for Tbil; 1.743-3.835 in tertile 1 and 1.416-3.144 in tertile 2 for Dbil; 2.361-5.345 in tertile 1 and 1.604-3.545 in tertile 2 for Ibil) when compared with tertile 3. Conclusions: Our findings suggest that lower bilirubin levels may indicate severe and multiple intracranial atherosclerotic stenoses.

中文翻译：

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急性缺血性卒中的血清胆红素水平和症状性颅内动脉粥样硬化狭窄程度：一项横断面研究。

背景：胆红素在脑卒中的病理机制中起着矛盾的作用。迄今为止，很少有临床研究调查血清胆红素对症状性颅内动脉粥样硬化狭窄 (sICAS) 的影响。本研究旨在评估血清胆红素与 sICAS 之间的联系。方法：2015年9月至2020年5月，我院收治的1156例无肝胆疾病的sICAS患者。根据动脉狭窄程度将患者分为非轻度 (0-49%)、中度 (50-69%) 和重度闭塞 sICAS 组 (70-100%)。中度和重度闭塞 sICAS 患者根据狭窄动脉的数量（单支、二支和多支血管狭窄）分为三组。采用logistic回归分析血清胆红素水平与sICAS的关系。结果：在单变量分析中，患有严重和多发性动脉粥样硬化狭窄的 sICAS 患者的总胆红素 (Tbil)、直接胆红素 (Dbil) 和间接胆红素 (Ibil) 水平较低。在多项逻辑回归分析中，与胆红素的最高三分位数相比，较低水平的 Tbil、Dbil 和 Ibil 显示出更高的严重闭塞 sICAS 风险（95% CI：Tbil 的三分位数 1 中的 2.018-6.075；2.380-7.410 在Dbil 的三分位数 1；Ibil 的三分位数 1 中的 1.758-5.641）。此外，逻辑回归分析表明，较低水平的 Tbil、Dbil 和 Ibil 与多次（≥3）动脉粥样硬化狭窄有关（95% CI：第 1 分位数为 2.365-5.298，第 2 分位数 Tbil 为 2.312-5.208；1.743-对于 Dbil，第 1 分位数为 3.835，第 2 分位数为 1.416-3.144；第 1 分位数和 1.604-3 为 2.361-5.345。