血电解质和白蛋白浓度与冠状动脉病变严重性的关系

Correlations of serum electrolytes and albumin concentrations with severity of coronary artery disease

目的：探讨血电解质钠、钾、钙及白蛋白浓度与冠状动脉病变严重程度的关系。方法：回顾性分析358例冠心病介入诊疗者资料,其中冠心病者（冠心病组）286例,含急性心肌梗死（AMI）者51例,陈旧性心肌梗死（OMI）者56例,无心肌梗死（MI）冠心病者179例;冠状动脉造影（CAG）示无粥样硬化改变者（对照组）72例。采用Gensini积分系统评定冠状动脉病变严重性。结果：冠心病组中,平均冠状动脉病变Gensini积分AMI亚组[39（27~72）]最高,OMI亚组[36（22~57）]次之,无MI冠心病亚组[28（15~42）]最低（P〈0.01）;冠心病组患者平均血钙[AMI：（2.13±0.29）mmol/L,OMI：（2.34±0.22）mmol/L,无MI冠心病：（2.36±0.22）mmol/L]和白蛋白[AMI：（38.5±5.1）g/L,OMI：（41.3±3.9）g/L,无MI冠心病：（41.6±3.6）g/L]均明显低于对照组[血钙：（2.42±0.15）mmol/L,白蛋白：（42.8±4.0）g/L],均P〈0.05,其中AMI亚组平均血钙和白蛋白还均明显低于其他冠心病亚组（均P〈0.05）;AMI亚组平均血钠、钾与其他亚组比较（除血钾与OMI亚组比较）也均明显较低（均P〈0.05）。血钙和白蛋白与冠状动脉病变Gensini积分呈显著负相关,血钙r=-0.175（P=0.003）,白蛋白r=-0.200（P=0.001）,而血钠、钾与Gensini积分无明显相关性（均P〉0.05）;logistic回归分析示,经年龄、性别、糖尿病等传统危险因素调整后,低钙血症仍为冠心病危险因素（OR=2.618,95%CI=1.025~6.690,P=0.044）。结论：AMI可能会使血钠、钾、钙和白蛋白水平降低,血钙和白蛋白浓度与冠状动脉病变严重程度显著负相关,且低钙血症可能为冠心病的独立危险因素。

Objective：To explore the associations of serum sodium,potassium,calcium and albumin concentrations with severity of coronary artery disease（CAD）.Method：A retrospective study was conducted to analyze 358 patients in Wuhan Union Hospital in 2008.The patients were divided into 4 groups,51 acute myocardial infarction（AMI） patients,56 old myocardial infarction（OMI） patients,179 CAD patients without myocardial infarction（MI）,and 72 normal control subjects.Gensini scoring system was utilized to evaluate the severity of CAD.Result：The average Gensini score in AMI patients was the highest（39[27 to 72]）,the score in OMI patients with was a little lower（36[22 to 57]）,and the score in CAD patients（without MI） was the lowest（28[15 to 42]）.The average concentrations of serum calcium（AMI： [2.13±0.29]mmol/L,OMI： [2.34±0.22]mmol/L,CAD without MI： [2.36±0.22]mmol/L） and albumin（AMI： [38.5±5.1]g/L,OMI： [41.3±3.9]g/L,CAD without MI： [41.6±3.6]g/L） in patients with 3 CAD groups were significantly lower than the control group（serum calcium： [2.42±0.15]mmol/L,albumin： [42.8±4.0]g/L）,all P0.05,the average concentrations of serum calcium and albumin in patients with AMI were significantly lower than other CAD groups（all P0.05）,and the average concentrations of serum sodium and potassium in patients with AMI were also significantly lower than the other groups（except OMI group in serum potassium）（all P0.05）.The negative correlations of serum calcium and albumin concentrations with Gensini score were significant in all patients,the spearman＇s r of serum calcium was-0.175.The concentration of serum sodium and potassium had no obvious correlation with Gensini scores（P0.05）.The logistic analysis showed hypocalcemia was still the risk factor of coronary atery disease after adjustment of the traditional risk factor such as age,sex and diabetic mellitus concentrations with Gensini score were significant in all patients,the spearman＇s r of serum calcium was-0.175（P=0.003）,and of serum albumin was-0.200（P=0.001）,but there were no significant associations of serum sodium and potassium concentrations with Gensini score（both P0.05）.Results of logistic regression indicated that hypocalcemia was a risk factor for CAD（OR=2.618,95%CI： 1.025-6.690,P=0.044） when adjusted for conventional risk factors.Conclusion：The lower levels of serum sodium,potassium,calcium and albumin concentrations may be caused by AMI,there are significant negative correlations of serum calcium and albumin concentrations with severity of CAD,and hypocalcemia may be an independent risk factor for CAD.