血清胆红素与冠脉病变程度、血脂及冠心病中医证型关系

Relationship of Serum Bilirubin to Severity of Pathological Changes of Coronary Artery,Blood Lipid and TCM Syndrome Types of Coronary Heart Disease

目的探讨血清胆红素与冠脉病变程度、血脂的关系及血清胆红素与冠心病中医证型的相关性。方法根据冠脉造影结果，分为冠心病组和非冠心病组，采用Gensini法计算冠脉病变积分（CSS），检测空腹血清总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）、总胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白胆固醇（HDL-C）水平。冠心病中医证型分为心气虚弱型、心肾阴虚型、痰阻心脉型、心血瘀阻型4个证型。结果①冠心病组TBIL、IBIL低于非冠心病组（P〈0．05）。TBIL、DBIL、IBIL与冠脉病变积分成负相关。②TBIL、DBIL、IBIL与LDL-C成负相关，与HDL-C成正相关；IBIL还与TG成负相关。③不同证型间TBIL、IBIL有差异（P〈0．01），心血瘀阻型TBIL、IBIL水平低于心气虚弱型、心肾阴虚型、痰阻心脉型（P〈0．01，0．05）。结论①血清胆红素降低可能促进了冠脉病变程度的加重。②血清胆红素与血脂相关，可能参与了血脂代谢。③血清胆红素与冠心病中医证型相关。可为冠心病中医辨证分型提供客观依据。

OBJECTIVE To explore into the correlation of serum bilirubin to the severity of the pathological changes of the coronary artery, blood lipid and the TCM syndrome types of coronary heart disease. METHOD The subjects were divided into a group with coronary heart disease and a group without the disease. Gemini Method was used to calculate the levels of CSS, TBIL, DBIL, IBIL, TC, TG and HDL-C. Those with coronary heart disease were divided into four syndromes： deficiency of heart qi, deficiency of yin of the heart and kidney, obstruction of the heart vessel by phlegm, and heart blood stasis. RESULT （ 1 ） The levels of TBIL and IBIL in the treatment group was found to be higher than those in the control group （ P 〈 0.05） ; TBIL, DBIL and IBIL were negatively correlated to the integral of the pathological changes of the coronary artery. （2） TBIL, DBIL and IBIL were negatively correlated to LDL-C but positively correlated to HDL-C; IBIL was negatively correlated to TG. （3） TBIL and IBIL varied with different syndromes （ P 〈 0.01 ）, with TBIL and IBIL in the syndrome of deficiency of heart qi lower then those in other syndromes （ P 〈 0.01- 0.05）. CONCLUSION （ 1 ） The reduction of the level of serum bilirubin can increase the severity of the pathological changes of coronary artery. （2） Serum bilirubin is correlated to the blood lipid, probably because of its participation of blood lipid metabolism. （3） Serum bilirubin is correlated to the TCM syndromes of coronary heart disease, and can provide basis for the differential diagnosis and treatment of coronary heart disease.