冠状动脉病变程度与胆红素血脂指数及纤维蛋白原水平的关系

Correlation between severity of coronary artery disease and comprehensive index of bilirubin and fibrinogen

目的:研究胆红素血脂综合指数和纤维蛋白原水平与冠状动脉病变程度的关系。方法:选取患者300例,均行冠状动脉造影,按照2种方法进行分组:①根据造影结果,无冠心病者为对照组(75例),冠心病者为观察组(225例);②根据冠状动脉病变程度将患者分为4组:A组无血管病变(75例),B组单支血管病变(119例),C组2支血管病变(54例),D组3支或主干血管病变(52例)。抽取所有患者空腹血,检测血浆总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及纤维蛋白原(FIB)水平,并计算出胆红素血脂综合指数。结果:①观察组患者TC、LDL-C、胆红素血脂综合指数[LDL-C/(HDL-C+TBIL)、TC/(HDL-C+TBIL)]及纤维蛋白原较对照组均有所升高,差异有统计学意义(P<0.05);观察组患者HDL-C、DBIL、IBIL及TBIL均低于对照组,差异有统计学意义(P<0.05);②以冠状动脉病变程度分组的比较中,TBIL、IBIL、LDL-C、LDL-C/(HDL-C+TBIL)、TC/(HDL-C+TBIL)及纤维蛋白原水平的差异均有统计学意义(P<0.05);③Logistic危险因素分析显示,胆红素血脂综合指数LDL-C/(HDL-C+TBIL)、TC/(HDL-C+TBIL)及纤维蛋白原的优势比(OR)分别为1.75、1.65、2.01;可信区间分别为1.02~2.86、1.05~2.77、1.63~3.02,均是冠心病的危险因素;④相关性分析显示,胆红素血脂综合指数与冠心病患者Gensini积分呈正相关性(r=0.60,r=0.56,P<0.05);纤维蛋白原与冠心病患者Gensini积分亦呈正相关性(r=0.32,P<0.05)。结论:胆红素血脂综合指数和纤维蛋白原水平与冠状动脉病变程度呈正相关性,胆红素血脂综合指数与纤维蛋白原水平随着冠状动脉病变程度加重而升高。

Objective:To study the relationship between bilirubin-lipid index and fibrinogen levels and the severity of coronary artery disease.Method:A total of 300 patients in Department of Cardiology of our hospital were selected.All patients received coronary angiography,and were divided into two groups according to the two methods:①according to the imaging results,those without coronary heart disease were the control group(75 cases),and those with coronary heart disease were the observation group(225 cases).②according to the severity of coronary artery disease,the patients were divided into group A:non-vascular disease(75 cases),group B:single-vessel disease(119 cases),group C:2-vessel disease(54 cases),and group D:3-vessel disease(52 cases).Serum total bilirubin(TBIL),direct bilirubin(DBIL)and indirect bilirubin(IBIL),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and fibrinogen(FIB)level of all patients were detected,and the bilirubin blood lipid comprehensive index was calculated.Result:①The combined indexes of TC,LDL-C,bilirubin and lipid[LDL-C/(HDL-C+TBIL),TC/(HDL-C+TBIL)]and fibrinogen were increased in the observation group compared with the control group,with statistically significant differences(P<0.05).Patients in the observation group had lower HDL-C,DBIL,IBIL and TBIL than those in the control group,and the difference was statistically significant(P<0.05).②In the comparison of the severity of coronary artery disease,there were statistically significant differences in TBIL,IBIL,LDL-C,LDL-C/(HDL-C+TBIL),TC/(HDL-C+TBIL)and fibrinogen levels(P<0.05).③Logistic risk factor analysis showed that the ratio of LDL-C/(HDL-C+TBIL),TC/(HDL-C+TBIL)and fibrinogen was 1.75,1.65 and 2.01,respectively.The confidence intervals were:1.02-2.86),1.05-2.77 and 1.63-3.02,which were all risk factors for coronary heart disease.④Correlation analysis showed that the comprehensive index of bilirubin blood lipid was positively correlated with the Gensini integral of patients with coronary heart disease(r=0.60,r=0.56,P<0.05).Fibrinogen was positively correlated with Gensini integral in patients with coronary heart disease(r=0.32,P<0.05).Conclusion:The comprehensive index of bilirubin and serum lipid and the level of fibrinogen are positively correlated with the severity of coronary artery disease.