辅助诊断冠心病新指标探讨

目的 研究总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、高敏C反应蛋白(hs-CRP)、同型半胱氨酸(HCY)等新指标与冠心病的关系.方法 选取2014年12月至2016年4月在我院心内科住院并行冠脉造影的患者497例,其中冠心病组333例,非冠心病组164例.记录每例患者的基本资料,以及TBIL、DBIL、IBIL、hs-CRP、HCY等检测水平,分析各项指标与冠心病的关系.结果 冠心病组患者的TBIL、IBIL明显低于非冠心病组(10.54±3.5)μmol/L vs(14.03±3.78)μmol/L,(7.85±2.73)μmol/L vs(11.44±3.24)μmol/L],而hs-CRP、HCY明显高于非冠心病组(6.91±3.15)mg/L vs(3.24±2.21)mg/L,(11.79±3.80)μmol/L vs(6.87±2.40)μmol/L],差异均有显著统计学意义(P<0.01);两组患者的DBIL比较差异无统计学意义(3.46±1.55)μmol/L vs(3.68±1.54)μmol/L,P>0.05);随着冠心病冠脉病变支数的增加,TBIL、IBIL逐渐降低(P<0.01),hs-CRP、HCY逐渐增加(P<0.01),而DBIL随冠心病的病变支数增加则无明显变化(P>0.05);多因素Logistic回归分析结果显示,TBIL、IBIL与冠心病的发生呈负相关性(OR分别为0.838、0.787,P<0.01);DBIL与冠心病的发生未见明显相关性(P=0.651);hs-CRP、HCY与冠心病的发生呈现正相关性(OR分别为1.399、1.539,P<0.01).结论 TBIL、IBIL水平降低,hs-CRP、HCY水平升高与冠心病密切相关,低水平TBIL、IBIL与高水平hs-CRP、HCY均为冠心病患者的独立危险因素,可以作为评估冠状动脉病变的辅助新指标.

Investigation on the new indicators for auxiliary diagnosis of coronary heart disease

Objective To explore the relationship of total bilirubin (TBIL), direct bilirubin (DBIL), indirect bil-irubin (IBIL), hyper-sensitive C-reactive protein (hs-CRP), homocysteine (HCY) with coronary heart disease (CHD). Methods A total of 497 patients, who admitted to our Hospital and underwent coronary angiography from December 2014 to April 2016, were selected and divided into CHD group (n=333) and non-CHD group (n=164). The basic infor-mation of each patient and the levels of TBIL, DBIL, IBIL, hs-CRP, HCY were recorded, and the relationship between the indexes and CHD was analyzed. Results TBIL and IBIL in the CHD group were (10.54±3.5)μmol/L and (7.85± 2.73)μmol/L, which were significantly lower than (14.03±3.78)μmol/L and (11.44±3.24)μmol/L in the non-CHD group (P<0.01). hs-CRP and HCY in the CHD group were respectively (6.91 ± 3.15) mg/L and (11.79 ± 3.80) μmol/L, which were significantly higher than (3.24 ± 2.21) mg/L and (6.87 ± 2.40)μmol/L in the non-CHD group (P<0.01). There was no significant difference between the CHD and non-CHD group in DBIL with (3.46±1.55)μmol/L vs (3.68±1.54)μmol/L (P>0.05). With the increase of coronary artery disease, TBIL and IBIL gradually decreased (P<0.01), and CRP and HCY gradually increased (P<0.01), while DBIL showed no changes (P>0.05). Multivariate logistic regression analysis showed that CHD were negatively correlated with TBIL and IBIL (r=0.838, r=0.787, P<0.01), had no significant correla-tion with DBIL and hs-CHD (P=0.651), and was positively correlated with hs-CPR, HCY (r=1.399, r=1.539, P<0.01). Conclusion The levels of TBIL, DBIL, hs-CRP and HCY are closely related to coronary heart disease. Low levels of TBIL, IBIL and high levels of hs-CRP and HCY are independent risk factors in patients with CHD, and could be used as the new auxiliary indexs in the assessment of CHD.