急性冠状动脉综合征患者早期血清胆红素水平的变化

Changes of serum bilirubin level in patients with acute coronary syndrome

目的观察急性冠状动脉综合征(ACS)患者早期血清胆红素水平的动态变化并探讨其临床意义。方法选择稳定型心绞痛(SAP)患者28例,发病在24h内的ACS患者88例,包括不稳定性心绞痛(UAP)36例和急性心肌梗死(AMI)52例。测定其血清总胆红素(Tbil)、直接胆红素 (Dbil)和间接胆红素(Ibil)水平,并与40例健康人进行对照比较。ACS患者于发病第7天和第14天时分别复查上述指标。结果 SAP患者其血清Tbil和Ibil均显著低于对照组(P<0．05);而ACS患者无论是UAP还是AMI,其Tbil和Ibil均明显高于对照组(P<0．05),ACS患者发病第7天即显著下降(P<0．05),第14天时又有进一步降低。而Dbil水平在各组间均无显著性差异(P>0．05)。结论 ACS患者在发病后其Tbil和Ibil水平明显升高,发病7-14天后即显著降低。Tbil和Ibil水平的升高可能与斑块活化、不稳定有关。

Objective To investigate the changes of serum bilirubin level and its clinic value in patients with acute coronary syndrome （ACS）. Methods 28 patients with stable angina pectoris （SAP） , 88cases with ACS attacked within 24 hours among which 36patients with unstable angina pectoris （UAP）and 52patients with acute myocardial infarction （AMI）as well as 40 healthy subjects were studied. Serum total bilirubin （Tbil）, direct bilirubin （Dbil） and indirect bilirubin （Ibil） were measured. The measurement of theabove indexes was repeated at seventh and fourteenth day after being attacked with ACS. Results The levels of serum Tbil and Ibil in SAP were both lower significantly than those in normal subjects （ P 〈 0.05 ）, butthey were higher obviously in both UAP and AMI patients than those in healthy subjects （ P 〈 0.05 ）. Thelevels of serum Tbil and Ibil in ACS were all decreased significantly after 7 days of being attacked （ P 〈0.05）. They were lower further at fourteenth day after being attacked. There were no significant differencesof serum Dbil level among SAP, ACS and normal subjects （P 〉 0.05）. Conclusion The levels of serumTbil and Ibil in patients with ACS were higher significantly after being attacked, but they were decreased obviously after 7 - 14 days of being attacked. The increasing of Tbil and Ibil level may be associated with activation and unstableness of atherosclerosis plaque.