无症状老年冠心病患者微量白蛋白尿和血浆可溶性血栓调节蛋白水平的关系

Research on the relationship between microalbuminuria and plasma soluble thrombomodulin in elderly patients with asymptomatic coronary heart disease

目的探讨无症状老年冠心病患者微量白蛋白尿与血浆可溶性血栓调节蛋白的关系。方法106例无症状老年冠心病患者，分为无蛋白尿组和蛋白尿组，50例非冠心病住院患者为对照组。测定血浆可溶性血栓调节蛋白和尿微量白蛋白水平，并进行人体学测量及血清生化指标测定，并进行相关和回归分析。结果与对照组比较，无蛋白尿无症状老年冠心病组血浆可溶性血栓调节蛋白水平（3．36±1．27）μg／L比（13．96±1．33）μg／L升高，伴微量蛋白尿的无症状老年冠心病组血浆可溶性血栓调节蛋白水平（17．36±7．48）μg／L进一步升高。老年冠心病患者蛋白尿与血浆可溶性血栓调节蛋白、病程、糖尿病史、高血压以及血肌酐水平呈正相关（P〈0．05），与性别、血脂水平、血尿酸和体质指数无明显相关性（P〉0．05），多元线性回归分析显示，在校正了性别、血脂水平、尿酸等指标后血浆可溶性血栓调节蛋白、高血压、糖尿病以及年龄是老年冠心病患者蛋白尿水平的独立危险因素。结论老年冠心病患者在无症状阶段即可出现尿微量白蛋白与血浆血栓调节蛋白水平的升高，且二者之间呈正相关，提示早期监测患者尿微量白蛋白与血浆血栓调节蛋白水平可能有助于延缓冠心病的进展。

Objective To investigate the relationship between microalbuminuria and plasma soluble thrombomodulin in elderly patients with asymptomatic coronary heart disease. Methods 106 elderly patients with asymptomatic coronary heart disease were divided into non-microalbuminuria group and microalbuminuria group,and another 50 patients without coronary heart disease were set as control group. The levels of plasma soluble thrombomodulin and microalbuminuria were determined, the differences between two groups and the correlation between plasma soluble thrombomodulin and microalbuminuria were assessed. Results The level of plasma soluble thrombomodulin was（3.36±1.27）μg/L in the control group, （13.96 ± 1.33）μg/L in non-microalbuminuria group, and （17.36 ± 7.48）μg/L in microalbuminuria group, with obvious difference among groups. There were positive correlations of microalbuminuria with plasma soluble thrombomodulin, course of CHD, history of diabetes, hypertension,and serum creatinine levels in elderly patients with coronary heart disease （all P〈0.05）. There was no significant correlation of microalbuminuria with gender, the level of blood lipid and UA and BMI （all P 〈 0.05）. The multiple linear regression analysis showed that after adjusting for gender, blood lipid and UA, plasma soluble thrombomodulin, history of diabetes, hypertension and age were independent risk factors for microalbuminuria in elderly patients with coronary heart disease. Conclusions Microalbuminuria and plasma soluble thrombomodulin can appear in asymptomatic stage in elderly patients with coronary heart disease, and there is a positive correlation between microalbuminuria and plasma soluble thrombomodulin, which suggests that early monitoring of microalbuminuria and plasma soluble thrombomodulin could probably contribute to the delayed coronary heart disease progression.