老年高血压患者胆红素、血脂水平与冠状动脉病变严重程度的相关性分析

Correlation analysis of bilirubin,blood lipid level and coronary artery disease severity in elderly hypertensive patient

目的探讨老年高血压患者冠状动脉病变程度与胆红素、血脂水平的关系。方法选取217例老年高血压患者,将冠状动脉主要血管或分支狭窄≥50%的患者165例作为观察组,狭窄<50%患者52例作为对照组。观察组按病变支数分为单支病变、双支病变、多支病变亚组(分别为47、41、77例)。比较各组胆红素、血脂等生化指标差异及Gensini评分。结果观察组高密度脂蛋白胆固醇(HDL-C)及血胆红素水平明显低于对照组,三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平显著高于对照组,差异均有统计学意义(P<0.05);双支及多支病变亚组TG高于单支病变亚组及对照组,单支及多支病变亚组LDL-C水平高于对照组,双支病变亚组低于单支病变亚组,多支病变亚组高于单支及双支病变亚组,单支及多支病变亚组HDL-C水平低于对照组,且多支病变亚组低于双支病变亚组,双支及多支病变亚组血胆红素水平明显低于单支病变亚组和对照组,多支病变亚组低于双支病变亚组,差异均有统计学意义(P<0.05);单支、双支及多支病变亚组Gensini评分高于对照组,且积分随冠状动脉病变程度的加重而增高,差异均有统计学意义(P<0.01)。冠心病患者Gensini评分与胆红素水平呈明显负相关(r=-0.161～-0.400,P<0.01～0.05)。结论胆红素水平生理范围内增高是延缓老年高血压病发展为冠心病的保护因素,与冠状动脉病变程度呈负相关;早期干预胆红素水平有可能延缓老年高血压的发展并改善其预后。

Objective To investigate the relationship between bilirubin,blood lipid level and coronary artery disease severity in elderly hypertensive patient.Methods Chose 217 cases elderly hypertensive patients,and set the 165 cases patients with coronary major blood vassels or branches stenosis≥ 50% as observation group,52 cases patients with stenosis 50% as control group.Patient in observation group were dividide into single vessel subgroup（47 cases）,double vessel subgroup（41 cases）,and multi vessels subgroup（77 cases） according to the number of diseased vessels.Compared the Gensini score and differences of lipids,bilirubin and other biochemical indicators of each group.Results HDL-C and bilirubin level of observation group were lower than those of control group,TG,LDL-C level were higher than those of control group,the differences were statistically significant（P〈0.05）.TG level of double and multi vessels subgroup were higher than those of single vessel subgroup and control group;LDL-C level of single and multi vessels subgroup were higher than those of control group,and double vessel subgroup was lower than single vessel subgroup,multi vessels subgroup was higher than double and single vessel subgroup;HDL-C level of single and multi vessels subgroup was lower than those of control group,and multi vessels subgroup was lower than double vessel subgroup;Bilirubin level of double and multi vessels subgroup were lower than those of single vessel subgroup and control group,multi vessels subgroup was lower than double vessels subgroup,the difference were statistically significant（P〈0.05）.Gensini score of single,double and multi vessels subgroup were higher than that of control group,and the score increased with the severity of coronary artery lesions（P〈0.05）.Gensini score of patients with coronary artery disease and bilirubin level were negatively correlated（r =-0.161^-0.400,P〈0.01~0.05）.Conclusion Bilirubin levels increased within the physiological range is protective factors for delaying elderly patients with hypertension develop to coronary heart disease,and is negatively correlated with the severity of coronary lesions;Early intervention in bilirubin levels may delay the development and improve the prognosis of elderly patient with hypertension.