血清胆红素水平与冠状动脉粥样硬化的关系

Relationship between serum bilirubin level and coronary arteriosclerosis

目的研究血清胆红素水平以及胆红素与血脂的综合指标与冠状动脉粥样硬化的关系。方法选取96例于我院行冠状动脉造影术的冠状动脉粥样硬化性心脏病（CHD）患者，根据临床症状、心肌损伤标志物、心电图以及冠状动脉造影（简称“冠造”）时机分为因急性ST段抬高型心肌梗死行急诊冠造组及临床疑似或确诊冠心病行择期冠造组。测定患者血清总胆红素（TBIL）、间接胆红素（IBIL）、直接胆红素（DBIL）及计算TC／（HDL—C＋TBIL）、LDL—C／（HDL—C＋TBIL）比值。按照GENSINI评分评价冠状动脉病变严重程度。结果急诊冠造组患者TBIL水平明显高于择期冠造组中Gensini积分〉35分患者（P〈0．05）。近期未服用过降脂药物的择期冠造组患者，Gensini积分第一、二、三4分位组血清TC／（HDL—C＋TBIL）及LDL—C／（HDL—C＋TBIL）比值明显低于第四4分位组（P〈0．05）。而第一、二、三4分位组之间血清TC／（HDL—C＋TBIL）及LDL—C／（HDL—C＋TBIL）比值无明显统计学差异（P〉0．05）。C,ensini积分与TC／（HDL—C＋TBIL）的相关性（r=0．539，P〈0．001）及Gensini积分与LDL—C／（HDL—C＋TBIL）的相关性（r=0．488，P〈0．001）均高于传统血脂指标与狭窄积分的相关性：结论急性ST段抬高型心肌梗死患者TBIL反馈性升高。TC／（HDL—C＋TBIL）、LDL—C／（HDL—C＋TBIL）与冠状动脉狭窄评分的相关性高于传统血脂指标与冠脉狭窄程度的相关性。

Objective To study the serum bilirubin level and the relationship among bilimbin, lipid comprehensive indexes （LCi） and coronary, heart disease （CHD）. Methods The patients （ n = 96） with CHD after coronary arteriography were divided into group 1 [with emergency coronary arteriography due to acute ST-elevation myocardial infarction （STEMI） ] and group 2 （with selective coronary arteriography due to suspected or diagnosed CHD） according to the symptoms, markers in myocardial injury, electrocardiograms （ECG） and eoronary arteriography. The levels of serum total biliruhin （TBIL） , indirect bilirubin （IBIL） and direct bilirubin （DBIL） ,and the ratio of the total cholesterol （TC） to[ high density lipoprotein-cholesterol ＋ TBIL （ HDL-C ＋ TBIL） or low density lipoprotein-cholesterol （LDL-C） to （ HDL-C ＋ TBIL）] were calculated. The degree of CHD was reviewed by using Gensini scoring system. Results The level of TBIL in group 1 was higher significantly than that in the patients with Gensini scores over 35 in group 2 （ P 〈 0.05 ）. In group 2 in the patients without taking antihyperlipidemic agents at present the ratio of TC to （ HDL-C ＋ TBIL） or LDL-C to （HDL-C ＋ TBIL） in the first, second and third quartile groups was lower significantly than that in the fourth quartile group （ P 〈 0.05 ） , while the ratio among the first, second and third quartile groups was not different statistically （ P 〉 0.05 ）. The correlation between Gensini score and TC to （ HDL-C ＋ TBIL） （ r = 0. 539, P 〈 0. 001 ）, and that between Gensini score and LDL-C to （ HDL-C ＋ TBIL） （ r = 0. 488 ,P 〈 0. 001 ） were higher than the correlation between traditional LCI and stenosis scores. Conclusion The feedback of TBIL in the patients with acute STEMI is higher. The correlation between Gensini scores and TC to （ HDL-C ＋ TBIL） or LDL-C to （ HDL-C ＋ TBIL） is higher than that between traditional LCI and CHD.