尿视黄醇结合蛋白与老年冠心病患者心血管事件的相关性

The relationship of urinary retinal binding protein and risk of cardiovascular disease in aging people

目的探讨老年人尿视黄醇结合蛋白增高与心血管疾病危险性的关系。方法236例均为同济大学附属同济医院收治的老年冠心病患者,年龄70～89岁。按尿视黄醇结合蛋白(retinal binding protein,RBP)是否增高将患者分为两组:尿RBP增高组84例(尿RBP>10 mg/L)、尿RBP正常组152例(尿RBP≤10 mg/L)。每例患者均测体重指数(body weight index,BMI)、血压、空腹血糖、糖化血红蛋白、血肌酐、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-densitylipoprotein cholesterol,LDL-C)。均作12导联心电图和二维彩色多普勒心脏超声,其中63例行冠脉造影术。采用SPSS1.2统计软件进行统计检验。结果尿RBP增高组在血糖、血压、BMI、血肌酐、TG、LDL-C均明显高于尿RBP正常组;两组患者12导联心电图显示,尿RBP增高组有缺血性变化者占96.43%,尿RBP正常组为70.39%,卡方检验结果显示统计有显著性差异(P=0.008);超声心动图比较显示,左室射血分数(left ventrical eject fraction,LVEF)值低于0.5的发生率两组分别为63.09%和31.58%,卡方检验结果显示统计有显著性差异(P=0.042);尿RBP增高组与尿RBP正常组相比,LVEF明显降低(P=0.038);两组冠脉造影结果显示,尿RBP增高组单支病变患者少于双支或三支病变患者,尿RBP正常组双支及三支病变少于单支病变患者,尿RBP增高组血管病变弥漫受累程度高于尿RBP正常组,且血管狭窄程度>50%和/或血管完全闭塞者多。结论尿视黄醇结合蛋白增高不仅是老年人肾小管损伤的标志,也是心血管事件独立的预测因子和危险因素。

[Abstract] Objective To study the relationship between the increasing of urinary retinal binding protein （RBP）in aging people and risk of their cardiovascular disease. Methods 236 aging patients with coronary heart disease （CAD） were evaluated, from 70 to 89 years old. They were divided into 2 groups according to their plasma level of urinary retinal binding protein（RBP）. Several parameters such as body weight index （BMI）, blood pressure（BP）, plasma lipids level, glucose metabolism were measured. Electrocardiogram （ECG） and echocardiography were used to detect their heart condition. Partly, 63 patients were evaluated by cardiac angiography. Parameters were analyzed by t test and x2 test. Results BP, BMI, glucose level, triglyceride （TG） level and the low density lipoprotein cholesterol （LDL-C） level in group with high level of urinary RBP were higher than those in control. ST-T changes occured in 96.43% patients with high urinary RBP and in 70.39% patients in control. Significant difference was found in left ventricular ejection fraction （LVEF） between two groups. In high urinary RBP group, patients suffered from two or three arteries were more than those suffered from single artery. Conclusion Urinary RBP is not only the marker of early renal tubular damage in aging people, but also the risk factor of cardiovascular disease.