姚友杰,杨敏华,许炳灿,王景峰

• 1:中山大学附属第二医院心内科
• 2:河南省中医院急诊科

摘要(Abstract)：

目的探讨血清尿酸、胆红素和超敏C反应蛋白与冠状动脉粥样硬化程度的关系,评价三者对冠心病的临床诊断价值。方法对429例疑诊冠心病而接受冠状动脉造影的患者均同期检测血清尿酸、胆红素和超敏C反应蛋白,并检测三酰甘油(甘油三酯,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)、尿素氮(BUN)和肌酐(Cr)。根据冠状动脉狭窄情况分为冠状动脉正常组(冠状动脉无狭窄,35例)、冠状动脉粥样硬化组(冠状动脉狭窄小于50%,97例)、冠状动脉单支病变组(仅有一支冠状动脉分支狭窄大于或等于50%,123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%,174例),并在每组内分高LDL-C亚组和正常LDL-C亚组。结果各组间总血尿酸水平依次呈递增趋势,多支病变组和单支病变组较正常组分别升高了35.0%(P<0.05)和27.9%(P<0.05);而多支病变组与单支病变组比较差异无统计学意义。各组直接胆红素水平呈依次递减趋势,多支病变组和单支病变组与正常组比较直接胆红素水平分别下降了38.2%和26.3%,差异均具有统计学意义(P均<0.05)。多支病变组和单支病变组比较差异也具有统计学意义(P<0.05)。间接胆红素各组间两两比较未发现统计学差异。超敏C反应蛋白水平多支病变组(0.934±0.826mg/L)和单支病变组(0.616±0.776mg/L)较正常组(0.164±0.432mg/L)均显著升高(P均<0.05);同时,多支病变组较单支病变组升高了51.6%(P<0.05)。在剔除了LDL-C影响后亚组分析中,也得出类似结果。单因素logistic回归结果表明血尿酸、直接胆红素和超敏C反应蛋白均为影响冠状动脉病变的因素,其中尿酸的OR值最大(OR5.347,95%CI3.365～8.495)。进一步多因素logistic回归分析表明,除LDL-C和血糖等冠心病的传统危险因素外,血尿酸和超敏C反应蛋白对冠状动脉病变的影响要强于直接胆红素(r值分别为1.124和2.113,P值分别为0.001和0.000)。结论(1)随着冠状动脉病变程度加重,尿酸和超敏C反应蛋白水平显著增高。冠心病患者直接胆红素浓度降低,间接胆红素与冠状动脉病变程度无明确关系。(2)尿酸和超敏C反应蛋白对冠心病的预测价值大于直接胆红素。

关键词(KeyWords)： 冠状动脉疾病;尿酸;胆红素;超敏C反应蛋白

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 姚友杰,杨敏华,许炳灿,王景峰

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