总胆红素与冠状动脉粥样硬化斑块进展的相关性分析

Clinical study of the correlation between total bilirubin and coronary lesion progression

目的探讨血清学指标对经皮冠状动脉介入(PCI)术后非靶血管斑块进展的影响。方法入选在解放军总医院成功进行冠状动脉造影并于5个月后回院复查的冠心病患者,共纳入300例患者,平均年龄为(60.17±11.37)岁。采用QAngioXA 7.2分析软件行冠状动脉定量分析,非靶血管的狭窄程度较前加重20%以上定义为斑块进展。发生斑块进展者60例,无进展者240例。患者于两次冠状动脉造影前测定血脂、尿酸以及总胆红素水平。结果 60例斑块进展患者中非靶血管狭窄程度由(24.15±11.89)%加重至(53.75±12.91)%。斑块进展组和无进展组首次造影时总胆红素(11.00±6.67)μmol/L vs(13.88±5.95)μmol/L,复查造影时总胆固醇(4.29±0.94)mmol/L vs(3.80±0.86)mmol/L、三酰甘油水平(1.97±1.18)mmol/L vs(1.59±0.87)mmol/L、低密度脂蛋白水平(2.45±0.62)mmol/L vs(2.09±0.74)mmol/L、高尿酸血症40.0%vs 21.7%,差异均具有统计学意义(P<0.05)。Logistic回归分析显示,低水平总胆红素是PCI术后非靶血管斑块进展的危险因素。结论低水平总胆红素是PCI术后非靶血管动脉粥样硬化斑块进展的危险因素。

Objective To assess the influence of serum marker on coronary lesion progression. Methods Three hundred patients who successfully received coronary angiography and received coronary angiography again at least 5 months later between January 1,2005 and December 31,2010 were selected;their mean age was （60.17± 11.37） years old. The software QangioXA 7.2 （Dutch） was used to analyze all the coronary vessels. 60 patients had coronary lesion progression,while 240 patients had no lesion progression. Lipid level, uric acid （UA） and total bilirubin （TBIL） were determined before angiography. Results The degree of stenosis of patients with coronary lesion progression rose from （24.15 ±11.89）% to （53.75 ± 12.91）%. The levels of TBIL,TC,TG,LDL-C and hyperuricemia in both groups at first angiography were different from those at the follow-up angiography. The difference was statistically significant. TBIL at first CAG （11.00 ＋ 6.67） Ixmol/L vs （13.88 -＋ 5.95） μmol/L;TC at fellow up （4.29 ± 0.94） mmol/L vs （3.80 ± 0.86） mmol/L;TG at follow up （1.97 ~ 1.18） mmol/L vs （1.59 ~ 0187） mmol/L;LDL at follow up （2.45 ±0.62） mmol/L vs （2.09 ± 0.74） mmol/L;hyperuricemia 40.0% vs 21.7%;respectively （P 〈 0.05）. Logistic regression showed that the low level of total bilirubin was the risk factor of lesion progression. Conclusion Low level of TBIL is the risk factor of coronary lesion progression after PCI.