冠心病心力衰竭患者血清总胆红素及尿酸水平及其与冠状动脉慢血流关系的研究

Levels of serum total bilirubin and uric acid and their relationship with coronary slow flow phenomenon in patients with coronary heart disease complicated with heart failure

目的分析冠心病(CHD)心力衰竭患者血清总胆红素(TBIL)和血尿酸(SUA)的水平及其与冠状动脉慢血流现象(CSFP)的关系。方法选择2016年1月至2021年3月陕西汉中市人民医院心内科收治的CHD心力衰竭且伴有CSFP患者178例作为观察组,选择同期收治的CHD心力衰竭冠状动脉血流正常患者129例作为对照组。应用校正心肌梗死溶栓试验TIMI帧数(TFC)诊断冠状动脉慢血流(SCF),将观察组患者分为单支SCF组74例(单支组)和两支及以上SCF组104例(多支组),并分别测定各组患者左前降支、回旋支以及右冠状动脉的TFC帧数值;使用氧化酶法测定患者TBIL和SUA水平,采用Pearson直线相关分析法分析其在CHD心力衰竭伴CSFP患者患者中的表达及其与TFC的关系,应用受试者工作特征曲线(ROC)探究其对CHD心力衰竭患者SCF程度的诊断效能。结果观察组患者的血清TBIL较对照组降低,而SUA及TFC均值均较对照组显著升高,差异均有统计学意义(P<0.05);多支组患者TBIL水平较单支组低,而SUA及TFC均值均较单支组高,差异均有统计学意义(P<0.05);经Pearson相关性分析结果显示,CHD心力衰竭伴CSFP患者血清TBIL与TFC均值呈负相关(r=-0.520,P<0.01),SUA与TFC均值呈正相关(r=0.572,P<0.01);SUA截点值为463.33μmol/L时诊断患者是否有CSFP有较高效能,其约登指数为0.826,曲线下面积(AUC)为0.868,敏感度、特异性分别为92.70%、89.92%;SUA截点值为498.92μmol/L时指导患者单支和多支SCF效能更高,其约登指数为0.815,AUC为0.866,敏感度、特异性分别为92.31%、89.19%。结论CHD心力衰竭伴CSFP患者TBIL水平降低,当SUA和TBIL分别为463.33μmol/L和13.81μmol/L时,其鉴别CHD合并心力衰竭患者是否出现冠状动脉慢血流均有较高效能,当SUA和TBIL分别为498.92μmol/L和12.48μmol/L时,其鉴别不同支数SCF具有较好效能。

Objective To analyze the levels of serum total bilirubin(TBIL)and serum uric acid(SUA)in patients with coronary heart disease(CHD)complicated with heart failure and their relationship with coronary slow flow phenomenon(CSFP).Methods A total of 178 patients with CHD and heart failure accompanied by CSFP who were treated in Department of Cardiology,Hanzhong People's Hospital between January 2016 and March 2021 were selected as observation group,and 129 patients with CHD and heart failure and normal coronary flow during the same period were enrolled as control group.The corrected myocardial infarction thrombolysis test TIMI frame count(TFC)was used to diagnose slow coronary flow(SCF).The patients in the observation group were divided into single-vessel SCF group(74 cases,single-vessel group)and two or more vessel SCF group(104 cases,multiple-vessel group).The TFC frame counts of left anterior descending artery,circumflex artery,and right coronary artery were determined in each group of patients.Oxidase method was used to determine the levels of TBIL and SUA in patients,and Pearson linear correlation analysis was adopted to analyze their expressions in patients with CHD complicated with heart failure accompanied by CSFP and their relationship with TFC.Receiver operating characteristic curve(ROC)was used to explore their diagnostic efficiency on SCF degree in patients with CHD and heart failure.Results Serum TBIL of observation group was decreased compared with that of control group,while SUA and average TFC were significantly increased compared with those of control group(P<0.05).The level of TBIL in multiple-vessel group was significantly lower than that in single-vessel group,while the SUA and average TFC were significantly higher than those in single-vessel group(P<0.05).Pearson correlation results showed that serum TBIL in patients with CHD heart failure and CSFP was negatively correlated with average TFC(r=-0.520,P<0.01),and SUA was positively correlated with average TFC(r=0.572,P<0.01).When the SUA cut-off value was 463.33μmol/L,it had high efficiency in the diagnosis of presence or absence of CSFP,and its Youden index,area under the curve(AUC),sensitivity,and specificity were 0.826,0.868,92.70%,and 89.92%,respectively.When the SUA cut-off value was 498.92μmol/L,it was more effective to guide single-vessel or multiple-vessel SCF,and its Youden index,AUC,sensitivity,and specificity were 0.815,0.866,92.31%,and 89.19%,respectively.Conclusion The TBIL level is reduced among patients with CHD complicated with heart failure and CSFP.When SUA and TBIL were 463.33μmol/L and 13.81μmol/L,respectively,the two levels have high efficiency in differentiating presence or absence of coronary slow flow phenomenon in patients with CHD complicated with heart failure.When SUA and TBIL were 498.92μmol/L and 12.48μmol/L,respectively,they have good efficiency in differentiating different counts of SCF.