血清脂蛋白(a)、胆红素水平与冠状动脉病变程度关系研究

目的 检测冠心病(CHD)患者的血清脂蛋白(a)和胆红素水平,并探讨其与CHD的关系.方法 对196例疑诊冠心病而接受冠状动脉造影的患者检测血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL).根据冠状动脉狭窄情况分为非冠心病组(冠状动脉狭窄小于50%,52例)、单支病变组(仅有一支冠状动脉分支狭窄大于或等于50%,53例)和多支病变组(有一支以上冠状动脉分支狭窄大于或等于50%,91例).分析影响冠状动脉病变的相关因素及冠状动脉病变程度与血脂、胆红素的关系.结果 各组间LDL-C、Lp(a)水平依次呈递增趋势,差异有统计学意义(P＜0.05)各组间间接胆红素水平呈依次递减趋势,多支病变组与非冠心病组、单支病变组差异有统计学意义(P＜0.05).单因素logistic回归结果表明血清脂蛋白(a)、间接胆红素均为影响冠状动脉病变的因素(回归系数分别2.125、-1.557,P＜0.01).进一步多因素logistic回归分析表明脂蛋白(a)对冠状动脉病变的影响要弱于低密度脂蛋白胆固醇、甘油三酯(0R值分别为1.238、5.031、3.996,95%CI分别为1.069-6.322、2.457-12.356、2.785-14.764).结论 血清Lp(a)水平升高、IBIL水平降低是CHD发病及病变程度的危险因素.Abstract：Objective To investigate the association of Lipoprotein (a) and bilirubin with coronary heart disease(CHD). Methods One hundred and ninty -six patients undergone coronary angiography and completed clinical examination of TC, TG, HDL - C, LDL - C, Lp ( a), TBIL, DBIL, IBIL were divided into the without coronary diseases group ( coronary artery stenosis ＜50% ,52 cases) ,the single vessel disease group(with only one vessel stenosis ≥50% ,53 cases) and the multi -vessel disease group (with more than one vessel stenosis ≥50% ,91 cases)according to the coronary angiographic results. The correlative factors of coronary lesion and the relationship between Lipid,bilirubin and the severity of coronary lesion were analyzed. Results Higher levels of LDL - C and Lp(a) were found in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group, significant difference was found in the LDL- C and Lp(a) level among the 3 groups(P＜0.05). The levels of IBIL were lower in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group,significant difference was found in indirect bilirubin level in the multi -vessel disease group compared with in the without coronary disease group and in the single vessel disease group(P＜0.05). Single factor logistic regression showed that Lp (a) and indirect bilirubin are both correlation factors with coronary lession (r =2. 125 and - 1. 557, P ＜0.01 respectively). Advanced multi - factor logistic regression showed weaker correlation of Lp (a) with coronary lesion compared with LDL - C and TG (OR = 1. 238,5.031 and 3.996,95% CI1.069 - 6.322,2.457 - 12.356,2.785 - 14.764 respectively). Conclusions High level of Lp(a) and Low level of IBIL in human significantly influence the severity of coronary heart disease(CHD).

Association of lipoprotein(a) and bilirubin with severity of coronary artery lesion

Coronary heart disease Coronary angiography Lipoprotein (a) Bilirubin