冠心病患者胆红素血脂综合指数与冠状动脉狭窄程度的相关性

Correlation between bilirubin blood lipid comprehensive indexes and the degree of coronary artery stenosis in patients with coronary heart disease

目的探讨冠状动脉粥样硬化性心脏病(CHD)患者胆红素血脂综合指数与冠状动脉狭窄程度的关系。方法选取行冠脉造影检查的疑似CHD患者198例,据冠脉造影结果分为CHD组(n=130)和非CHD组(n=68),收集2组患者入院时的年龄、性别、身高、体质量、高血压病史、糖尿病史、吸烟史、体质量指数(BMI)等一般资料;抽取2组患者入院后次日清晨空腹肘静脉血3 mL,采用酶法测定血清甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及胆红素(TBIL),并计算胆红素血脂综合指数LDL-C/(TBIL+HDL-C)和TC/(TBIL+HDL-C);对CHD患者用美国心脏协会的冠脉图像分级量化表进行Gensini评分,采用有序多分类Logistic回归分析冠脉病变严重程度的危险因素、Spearman相关分析各血脂指标及综合指标与Gensini积分的关系,取相关系数较高的前4个指标进行受试者工作特征曲线(ROC)曲线下面积分析。结果CHD组患者TC/(HDL-C+TBIL)、LDL-C/(HDL-C+TBIL)水平均明显增高(P<0.01),而TBIL明显降低(P<0.01),且TC/(HDL-C+TBIL)、LDL-C/(HDL-C+TBIL)随Gensini积分增高而增高,而TBIL随Gensini积分降低而降低(P<0.01);多因素Logistic回归分析TC/(HDL-C+TBIL)、LDL-C/(HDL-C+TBIL)均为CHD独立危险因素(P<0.01);ROC曲线分析提示TC/(HDL-C+TBIL)为CHD诊断最佳截点(cut off)值为0.429、特异性0.867及敏感性0.769,LDL-C/(HDL-C+TBIL)cut off值为0.209、特异性0.794及敏感性0.861。结论TC/(HDL-C+TBIL)、LDL-C/(HDL-C+TBIL)均为CHD独立危险因素,TBIL为CHD保护因素;TC/(HDL-C+TBIL)反映冠脉狭窄程度特异性高于LDL-C/(HDL-C+TBIL),但敏感性较低。

Objective To explore the relationship between bilirubin lipid comprehensive indexes and the degree of coronary artery stenosis in patients with coronary atherosclerotic heart disease(CHD).Methods One hundred and ninety-eight suspected CHD patients who had undergone coronary angiography were selected and divided into CHD group(n=130)and non-CHD group(n=68)according to the results of the coronary angiography,and patients'basic information like the age,gender,height,weight,medical history of hypertension,medical history of diabetes,smoking history,body mass index(BMI)was collected when hospitalised.3 mL of fasting cubital venous blood was drawn the next morning after admission to the hospital;enzymatic method was adopted to determine serum triglycerides(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and Bilirubin(TBIL),and bilirubin blood lipid comprehensive indexes,LDL-C/(TBIL+HDL-C)and TC/(TBIL+HDL-C),were calculatde;American Heart Association's coronary image grading and quantification table was adopted to abtain Gensini scores;Multivariate Logistic regression was adopted to analyse the risk factors for the severity of coronary artery disease;Spearman linear correlation was adopted to analyse the relationship between each blood lipid index and comprehensive index with Gensini scores.The area under the curve of the top 4 indicators with higher correlation coefficient was calculated in the receiver operator characteristic curve(ROC).Results In CHD group,the levels of TC/(HDL-C+TBIL)and LDL-C/(HDL-C+TBIL)increased significantly(P<0.01);TBIL decreased significantly(P<0.01).TC/(HDL-C+TBIL)and LDL-C/(HDL-C+TBIL)increased with the increase of Gensini score while TBIL decreased with the decrease of Gensini score(P<0.01).Multivariate Logistic regression analysis showed that TC/(HDL-C+TBIL)and LDL-C/(HDL-C+TBIL)were CHD independent risk factors(P<0.01).ROC analysis showed that the best TC/(HDL-C+TBIL)cut-off point(cut off value)for diagnosis of CHD was 0.429,specificity 0.867,and sensitivity 0.769;The best LDL-C/(HDL-C+TBIL)cut off value for diagnosis of CHD was 0.209,specificity 0.794,and sensitivity 0.861.Conclusion TC/(HDL-C+TBIL)and LDL-C/(HDL-C+TBIL)are CHD independent risk factors,and TBIL is a CHD protective factor.The specificity of TC/(HDL-C+TBIL)indicating coronary artery stenosis is higher than that of LDL-C/(HDL-C+TBIL)while the sensitivity is lower.