急性冠脉综合征患者血胆红素、纤维蛋白原、脂蛋白(a)的变化及与冠脉病变程度的关系

Changes of serum bilirubin,plasma fibrinogen and serum lipoprotein(a) and association of the severity of coronary artery lesion and them in patients with acute coronary syndromes

目的:探讨血清胆红素(Bil)、血浆纤维蛋白原(Fib)和血清脂蛋白(a)[Lp(a)]在急性冠脉综合征(ACS)患者中的变化及与冠脉病变程度的关系。方法:选择急性心肌梗死患者(AMI组)30例、不稳定性心绞痛患者(UAP组)38例、稳定性心绞痛患者(SAP组)23例、冠状动脉造影阴性者(对照组)28例,分别测定血清总胆红素(TBil)、直接胆红素(DBil)、间接胆红素(IBil)、血浆Fib和血清Lp(a)的水平,比较各组间有无差别,并分析它们与冠脉病变程度的关系。结果:1与对照组相比,TBil、DBil和IBil在AMI组、UAP组、SAP组均明显降低(P均<0.01),而且AMI组明显低于SAP组(P均<0.05),但与UAP组差异无显著性(P均>0.05),UAP组与SAP组相比,TBil明显降低(P<0.05),而DBil、IBil差异无显著性(P>0.05);AMI组Fib明显高于UAP组、SAP组与对照组(P均<0.01),但UAP组、SAP组和对照组相比Fib差异无显著性(P>0.05);Lp(a)四组间差异无显著性(P>0.05)。23支病变组TBil、DBil、IBil明显低于1支病变组(P均<0.05),与2支病变组差异无显著性(P>0.05);2支病变组DBil明显低于1支病变组(P<0.05),而TBil、IBil差异无显著性(P均>0.05);3支病变组Fib明显高于2支病变组、1支病变组(P均<0.05),而2支病变组与1支病变组差异无显著性(P>0.05);Lp(a)3支病变组、2支病变组、1支病变组组间差异无显著性(P>0.05)。3spearman相关分析显示冠脉狭窄积分与TBil、DBil、IBil呈负相关,与糖尿病史和Fib呈正相关(r分别为-0.311、-0.210、-0.311、0.299、0.335,P值均<0.05)。多元逐步回归分析显示TBil、糖尿病史及Fib对冠脉狭窄积分影响比较大。结论:血清Bil降低、血浆Fib升高与ACS的发生和冠脉病变严重程度密切相关,脂蛋白(a)与ACS以及冠脉病变程度关系可能不大。

Objective：To investigate the changes of serum total bilirubin（TBil）, serum direct bilirubin（DBil）,serum indirect bilirubin（IBil）,plasma fibrinogen（Fib） and serum lipoprotein（a）[ Lp（a）] and association of the severity of coronary artery lesion and them in patients with acute coronary syndromes（ACS）. Methods： 30 patients with acute myocardial infarction（AMI group）, 38 patients with unstable angina pectoris （UAP group）and 23 patients with stable angina pectoris（SAP group） were studied, and 28 coronary angiography negative subjects were taken as controls（control group）. The serum Bil,plasma Fib and serum Lp（a） were measured respectively. The levels of them in 4 groups and association of the severity of coronary artery lesion and them were analyzed. Results： ①Compared with control group, the levels of TBil,DBil and IBil among AMI group,UAP group and SAP group were significantly lower（P0.01）, and the levels of them in AMI group were significantly lower than them in SAP group（P0.05）, but compared with UAP group, there were no significant difference（P0.05）. The levels of TBil in UAP group was significantly lower than it in SAP group（P0.05）, but the levels of DBil and IBil were no significant difference（P0.05）. The levels of Fib in AMI group was significantly higher than it in UAP group,SAP group and control group（P0.01）, but the levels of Fib among UAP group,SAP group and control group were no significant difference（P0.05）. The levels of Lp（a） among four groups were no significant difference（P0.05）. ②The levels of TBil,DBil and IBil in triple branch lesions group was significantly lower than them in single branch lesion group（P0.05）, but compared with double branch lesions group, there were no significant difference（P0.05）. The levels of DBil in double branch lesions group was significantly lower than them in single branch lesion group（P0.05）, but the levels of TBil and IBil were no significant difference（P0.05）. The levels of Fib in triple branch lesions group was significantly higher than them in double branch lesions group and single branch lesion group（P0.05）, but the levels of Fib in single branch lesion group and double branch lesions group were no significant difference（P0.05）. The levels of Lp（a） among single branch lesion group,double branch lesions group and triple branch lesions group were no significant difference（P0.05）. ③Spearman correlation analysis showed： scores of coronary artery lesion were negatively related to the levels of TBil,DBil and IBil, and positively related to history of diabetes mellitus（DM） and the levels of Fib（spearman r：-0.311、-0.210、-0.311、0.299、0.335,P0.05）. Stepwise multiple linear regression showed that TBil, history of DM and Fib were associated with scores of coronary artery lesion. Conclusion： The levels of reduced Bil and elevated Fib are closely related with ACS and the severity of coronary artery lesion, but the levels of Lp（a） may be not related with them.