血清铁蛋白、氧化型低密度脂蛋白及总胆红素与冠状动脉粥样硬化性心脏病的关系

Relationship of Serum Ferritin,Oxidized Low Density Lipoprotein and Total Bilirubin in Patients with Coronary Heart Disease

目的探讨冠状动脉粥样硬化性心脏病(CHD)患者血清铁蛋白(SF)、血浆氧化型低密度脂蛋白(Ox-LDL)、血清总胆红素(TBIL)、血清铁蛋白与总胆红素的比值(SF/TBIL)、冠状动脉Gensini积分间的关系,评价SF/TBIL对CHD的诊断价值。方法选择冠状动脉造影确诊的CHD患者70例,非冠状动脉粥样硬化性心脏病(NCHD)患者62例,计算冠状动脉Gensini积分并测定总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、SF、TBIL、Ox-LDL、SF/TBIL。结果CHD组SF、Ox-LDL、SF/TBIL、LDL-C比NCHD组明显升高(P均<0.01),TBIL、HDL-C明显降低(P均<0.05);SF/TBIL与Ox-LDL及Gensini积分均呈正相关(r=0.481,P<0.01;r=0.604,P<0.01),对SF/TBIL行ROC曲线分析示曲线下面积为0.895(P<0.01),当SF/TBIL=16.555 9时诊断CHD的敏感度为85.7%,特异度为82.3%;SF与Ox-LDL及Gensini积分均呈正相关(r=0.423,P<0.01;r=0.534,P<0.01),TBIL与Ox-LDL及Gensini积分均呈负相关(r=-0.346,P<0.01;r=-0.484,P<0.01);TC、HDL-C、TBIL、SF/TBIL进入Logistic逐步回归方程。结论SF/TBIL是比SF或TBIL更全面客观地反映冠状动脉粥样硬化的影响因素,是CHD的危险因素,对CHD的诊断有一定价值,低胆红素水平和高血清铁蛋白水平在致CHD上存在协同作用。

Objective To investigate the relationship of serum ferritin （SF）, oxidized low density lipoprotein （Ox-LDL）, total bilirubin（TBIL）, the ratio of serum ferritin and total bilirubin （SF/TBIL） and Gensini scores in patients with coronary heart disease （CHD） and to appraise the diagnosis of CHD by measuring SF/TBIL. Methods Gensini scores, SF, TBIL, Ox-LDL, SF/TBIL, total cholesterol（TC） , triglycerides （TG）, high density lipoprotein （HDL-C） and low density lipoprotein （LDL-C） were calculated and measured in 70 CHD and 62 NCHD diagnosed by coronary arterography. Results CHD group showed significant high levels of SF, Ox- LDL, SF/TBIL, LDL-C（P 〈 0.01 ）, and low levels of TBIL and HDL-C（P 〈 0.05 ） when compared with NCHD group . In CHD group, Ox-LDL and Gensini scores were positively correlated with SF （ r = 0. 423, P 〈 0.01 ; r = 0. 534, P 〈 0.01 ） and SF/TBIL （ r = 0.481, P 〈 0.01 ; r = 0.604, P 〈 0.01 ） while negatively correlated with TBIL（ r = - 0. 346, P 〈 0.01 ; r = - 0. 484, P 〈 0.01 ）. To analyze SF/TBIL by ROC, the area under the ROC curve was 0. 895 （ P 〈 0.01 ） and the sensitivity and specificity of diagnosing CHD were 85.7% and 82.3% when SF/TBIL was 16. 555 9. TC, HDL-C, TBIL and SF/TBIL entered Logistic equation. Conclusion SF/TBIL, a risk factor of CHD, reflects the influential factors of coronary atheroselerosis more comprehensively and objectively than SF or TBIL. To CHD, SF/TBIL has certain diagnostic value. Both lower bilirubin and higher serum ferritin promote coronary heart disease.