血清总胆红素预测冠状动脉斑块稳定性的临床研究

Clinical study of the levels of total bilirubin for predicting coronary plaque stability

目的:探讨血清总胆红素浓度在预测冠状动脉斑块稳定性中的临床作用。方法:入选冠心病患者75例,依据疾病程度分为急性冠状动脉综合征(acute coronary syndrome,ACS)组40例,稳定型心绞痛(stable angina pectoris,SAP)组35例,另随机纳入非冠心病患者40例为正常对照(normal control,NC)组,行冠状动脉造影检查,进一步对冠心病患者行血管内超声(intravascular ultrasound,IVUS)检查,术前测定各组患者血清胆红素浓度,分析ACS组和SAP组冠状动脉斑块稳定性差异,比较3组患者血清胆红素水平及其与斑块性质关联性。结果:ACS组血清总胆红素、直接胆红素和间接胆红素水平均显著低于SAP组和NC组(P<0.05);IVUS显像特征显示ACS组管腔面积、纤维帽厚度显著低于SAP组,而斑块负荷、脂核大小、偏心指数、重构指数均显著高于SAP组(P<0.01);血清总胆红素水平与纤维帽厚度呈显著正相关(r=0.306,P<0.01),与脂核大小、偏心指数、重构指数呈显著负相关(r=-0.315、-0.324、-0.310,P<0.01)。结论:血清总胆红素与冠状动脉斑块稳定性呈显著正相关,可以作为临床预测冠心病患者斑块稳定性的血液学指标。

Objective：To investigate the role of the levels of total bilirubin in predicting coronary plaque stability.Method：Seventy-five coronary heart disease（CHD）patients were divided into acute coronary syndrome（ACS）group（n=40）and stable angina pectoris（SAP）group（n=35）according to condition of patients,and 40 nonCHD subjects served as normal control（NC）group.Coronary angiography was undergone in all subjects,among whom the patients with CHD had a further detection with intravascular ultrasound（IVUS）.Serum levels of bilirubin in all subjects were measured before operation.The stability of coronary plaque was compared between ACS group and SAP group,and the relationship between serum levels of bilirubin and feature of coronary plaque was analyzed in three groups.Result：The serum levels of total bilirubin,direct bilirubin and indirect bilirubin in ACS group were significantly lower than those in SAP group and NC group（P〈0.05）;IVUS indicated that lumen area and fibrous cap thickness in ACS group were significantly lower than those in SAP group,whereas plaque burden,size of lipid core,eccentricity index and remodeling index were significantly higher than those in SAP group（P〈0.01）;The levels of serum total bilirubin were positively with fibrous cap thickness（r=0.306,P〈0.01）,while were negatively associated with lipid core,eccentricity index and remodeling index（r=-0.315,-0.324,-0.310 respectively,P〈0.01）.Conclusion：Serum total bilirubin,as a hematological indicator is positively associated with coronary plaque stability in CHD patient.