老年冠心病患者同型半胱氨酸、总胆红素水平与颈动脉硬化的相关性

Correlation analysis of homocysteine and total bilirubin levels with carotid atherosclerosis in elderly patients with coronary atherosclerosis heart disease

目的探讨老年冠心病患者血浆中同型半胱氨酸(HCY)、血清中总胆红素(TBIL)与颈动脉内膜中层厚度(IMT)的相关性。方法选取本院收治的161例老年患者(>65岁)为研究对象,综合临床表现、动态心电图、冠脉CTA和冠脉造影对收治的老年患者分为冠心病组90例和非冠心病组71例,记录入选者的年龄、性别、身高、体质量、BMI指数和吸烟史等一般情况,检测空腹血糖(FPG)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白(HDL C)、低密度脂蛋白(LDL C)、尿素(BUN)、尿酸(UA)、肌酐(Cr)、HCY和TBIL等生化指标,同时进行颈动脉超声检查,检测IMT。结果两组年龄、性别、身高、体质量、BMI指数、吸烟史以及FPG、TC、TG、HDL C、LDL C、BUN、UA和Cr水平比较差异无统计学意义(P>0.05),冠心病组中HCY和IMT水平明显高于非冠心病组,且TBIL水平显著低于非冠心病组;经直线相关分析可知,老年冠心病患者血浆中HCY水平与颈动脉IMT呈正相关(r2=0.900 7,P=0.036),而血清中TBIL水平则与颈动脉IMT呈负相关(r2=0.874 4,P=0.028);在多元逐步回归分析中,颈动脉IMT随着HCY水平的增加而增加,随着TBIL水平的降低而增加。结论HCY水平升高和TBIL水平下降是老年冠心病患者颈动脉粥样硬化的重要影响因素,对评估和预测老年冠心病进展有重要价值。

Objective To investigate the correlation between the levels of plasma homocysteine(HCY),serum total bilirubin(TBIL)and carotid atherosclerosis in elderly patients with coronary atherosclerosis heart disease(CHD).Methods A sum of 161 cases of elderly patients(over age 65)with CHD from our hospital were enrolled as research object.According to clinical manifestation,dynamic electrocardiogram,computerized tomogra phy angiography(CTA)and coronary angiography,all case were divided into two groups:CHD group(n=90)and No CHD group(n=71),The general data(including age,sex,height,weight,BMI and smoking history)of the two groups were recorded,and pathological data including fasting blood glucose(FPG)total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL C),low density lipoprotein(LDL C),uric acid(UA),urea nitrogen(BUN),creatinine(Cr),plasma HCY and serum TBIL of the two groups was examined,carotid artery Intima media Thickness(IMT)of the two groups were detected by ultrasonic examination.Results There was no significant difference in age,sex,height,weight,BMI and smoking history,TC,TG,HDL C,LDL C,BUN,UA and Cr between the two groups(P>0.05).The levels of HCY and IMT were significantly higher in CHD group than in No CHD group(P<0.05),but TBIL level was significantly lower(P<0.05).Linear correlation analysis showed that plasma HCY level was positively correlated with carotid IMT level in elderly CHD patients(r2=0.9007,P=0.036),and TBIL level was negatively correlation with carotid IMT level in elderly CHD patients(r2=0.8744,P=0.028);The multivariate linear stepwise regression analysis also indicated that carotid IMT increased with the increase of HCY level and increased with the decrease of TBIL level.Conclusions The increase of plasma HCY level and decrease of serum TBIL were important influencing factor of carotid atherosclerosis in patients with CHD,and important value for evaluation and prediction on progression of coronary heart disease in the elderly.