老年急性冠脉综合征患者血清胆红素及尿酸与冠脉病变程度的相关性

目的：探讨老年急性冠脉综合征（ACS）患者血清胆红素、尿酸水平与冠状动脉病变严重程度之间的关系。方法选择2012年1月至2013年12月在我科因ACS住院并行冠脉造影检查的老年患者220例，分为不稳定性心绞痛组（UA）120例，急性心肌梗死组(AMI)100例。选择同期因胸痛住院，冠脉造影正常者87例为对照组。所有入选者均测定空腹血清胆红素及尿酸水平，并进行比较，急性冠脉综合征患者行冠脉造影检查，采用Gensini评分法评价冠状动脉损害程度，分析血清胆红素及尿酸水平与冠脉病变严重程度的关系。结果 UA组、AMI组患者的血清总胆红素浓度分别为（13.29±5.89）mmol/L、（11.48±5.35）mmol/L，均低于对照组（16.70±4.25）mmol/L，差异有统计学意义（P<0.05）；UA组、AMI组之间差异无统计学意义（P>0.05）。血清尿酸浓度分别为(348.06±119.96）mmol/L、（366.19±134.95）mmol/L，均高于对照组（267.70±114.97）mmol/L，差异有统计学意义（P<0.05）；UA组、AMI组之间差异不显著（P>0.05）。Gensini评分与血清胆红素及尿酸水平均呈显著相关（r值分别-0.344，0.351，P<0.05）。结论老年ACS患者血清胆红素水平明显降低，尿酸水平明显增高，且与冠状动脉病变的严重程度密切相关，对低胆红素、高尿酸血症的患者应给予高度重视，尽早予以强化治疗。

Correlation of serum bilirubin,serum uric acid and the severity of coronary artery disease in elder patients with ;acute coronary syndrome

Objective To investigate the correlation of serum bilirubin,serum uric acid and the severity of coro-nary artery disease in elder patients with acute coronary syndrome(ACS). Methods A total of 220 elderly acute coronary syndrome patients who received coronary angiography and hospitalized in the Department from January 2012 to Decem-ber 20l3 were included. We divided them into two groups, the unstable angina (UA) group (n=120), and the acute myocar-dial infarction(AMI) group (n=100). A normal control group was selected (n=87). Serum bilirubin and uric acid were test-ed for all subjects, and coronary angiography was performed in patients with acute coronary syndrome. Gensini scores were used for quantitative analysis of the degree of stenosis, and we analyzed the correlation of serum bilirubin,serum uric acid and the severity of coronary artery disease(CAD). Results Serum bilirubin levels in the three groups were (13.29 ± 5.89)mmol/L, (11.48 ± 5.35)mmol/L,(16.70 ± 4.25)mmol/L. Serum uric acid levels in the three groups were (348.06 ± 119.96)mmol/L,(366.19 ± 134.95)mmol/l,(267.70 ± 114.97)mmol/L respectively. Serum bilirubin,uric acid in the UA group and the AMI group were significantly different from the normal control group(P<0.05). There were no dif-ferences between the UA group and AMI group. Serum bilirubin and serum uric acid were both significantly correlated with Gensini score (r=-0.344,0.351, P<0.05). Conclusion The level of serum uric acid is significantly increased and the level of serum bilirubin is significantly decreased in elder patients with acute coronary syndrome. They correlates sig-nificantly with the severity of CAD. We should pay attention to these high risk patients and early initiation of intensive treatment to patients with low level serum bilirubin and high serum level of uric acid.