血清TBIL、Hcy、hs-CRP、UA水平与老年冠心病病人冠状动脉不稳定性斑块形成间的关系

doi:10.3969/j.issn.1003-9198.2022.01.020

摘要/Abstract

摘要： 目的探讨血清总胆红素(TBIL)、Hcy、hs-CRP、UA与老年CHD病人冠状动脉不稳定性斑块形成的关系。方法选取2019年4月至2021年4月我院收治的198例CHD病人为研究对象,依据颈动脉多普勒超声检查结果分为不稳定组(n=54)与稳定组(n=144)。对比2组基线资料信息及血清学指标水平,将有统计学意义的变量纳入多因素Logistic回归分析,明确老年CHD病人冠状动脉不稳定性斑块形成的危险因素。结果 2组性别、年龄、BMI、心率(HR)、SBP、DBP、高血压史、糖尿病史、吸烟史、饮酒史及血清TC、TG、LDL-C、HDL-C水平比较,差异无统计学意义(P＞0.05);不稳定组血清TBIL水平显著低于稳定组(P＜0.05),血清Hcy、hs-CRP、UA水平显著高于稳定组(P＜0.05)。ROC曲线分析显示,血清TBIL、Hcy、hs-CRP、UA均能用于老年CHD病人冠状动脉不稳定性斑块形成的预测,AUC分别为0.956、0.647、0.870、0.842(均P＜0.05)。多因素Logistic回归分析表明,血清TBIL≤7.985 μmol/L、Hcy≥12.725 μmol/L、hs-CRP≥3.895 mg/L、UA≥340.645 μmol/L为老年CHD病人冠状动脉不稳定性斑块形成的危险因素(均P＜0.05)。结论老年CHD病人冠状动脉不稳定性斑块形成与血清TBIL、Hcy、hs-CRP、UA水平关系密切,TBIL≤7.985 μmol/L、Hcy≥12.725 μmol/L、hs-CRP≥3.895 mg/L、UA≥340.645 μmol/L是预测病人冠状动脉不稳定性斑块形成的最佳截断值,值得临床医师关注。

关键词: 冠心病, 老年人, 冠状动脉不稳定性斑块, 尿酸, 总胆红素, 同型半胱氨酸, 超敏C反应蛋白

Abstract: Objective To investigate the relationship between serum total bilirubin (TBIL), homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP), uric acid (UA) and unstable coronary plaque formation in the elderly patients with coronary heart disease (CHD). Methods A total of 198 patients with CHD admitted to our hospital from April 2019 to April 2021 were enrolled in the study, and they were divided into the unstable group (n=54) and the stable group (n=144). The baseline data and serum indexes of the two groups were compared, and multivariate Logistic regression analysis was used to clarify the risk factors of unstable coronary plaque formation in the elderly patients with CHD. Results The level of serum TBIL in the unstable group was significantly lower than that in the stable group(P<0.05). The levels of serum Hcy, hs-CRP and UA in the unstable group were significantly higher than those in the stable group (P<0.05). Receiver operating characterise curve analysis confirmed that serum TBIL, Hcy, hs-CRP and UA could be used to predict the formation of unstable coronary plaque in the elderly patients with CHD, with an AUC of 0.956, 0.647, 0.870 and 0.842, respectively (P<0.05). Multivariate Logistic regression analysis confirmed that serum TBIL≤7.985 μmol/L, Hcy≥12.725 μmol/L, hs-CRP ≥3.895 mg/L and UA≥340.645 μmol/L were the risk factors for coronary unstable plaque formation in the elderly patients with CHD (P<0.05). Conclusions The formation of unstable coronary plaque in the elderly patients with CHD is closely related to the expression of serum TBIL, Hcy, hs-CRP and UA. TBIL≤7.985 μmol/L, Hcy≥12.725 μmol/L, hs-CRP≥3.895 mg/L, UA≥340.645 μmol/L are the best cut-off values for predicting the formation of unstable coronary plaque.

Key words: coronary heart disease, aged, unstable coronary plaque, uric acid, total bilirubin, homocysteine, hypersensitive C-reactive protein

中图分类号:

R 541.4

张倩, 袁静, 徐小英, 范家伟, 吴发国. 血清TBIL、Hcy、hs-CRP、UA水平与老年冠心病病人冠状动脉不稳定性斑块形成间的关系[J]. 实用老年医学, 2022, 36(1): 77-80.

ZHANG Qian, YUAN Jing, XU Xiao-ying, FAN Jia-wei, WU Fa-guo. Relationship between serum TBIL, Hcy, hs-CRP, UA and unstable coronary plaque formation in elderly patients with coronary heart disease[J]. Practical Geriatrics, 2022, 36(1): 77-80.

参考文献

[1] CYBULSKA B, KŁOSIEWICZ-LATOSZEK L. Landmark studies in coronary heart disease epidemiology. The Framingham Heart Study after 70 years and the Seven Countries Study after 60 years[J]. Kardiol Pol, 2019, 77(2):173-180.
[2] NDREPEPA G, COLLERAN R, KASTRATI A. Gamma-glutamyl transferase and the risk of atherosclerosis and coronary heart disease[J].Clin Chim Acta, 2018, 76(7):130-138.
[3] KOCHERGIN N A, KOCHERGINA A M, GANYUKOV V I, et al. Predictors of coronary plaque vulnerability in patients with stable coronaryartery disease[J]. Kardiologiia, 2020, 60(10):20-26.
[4] 吴湘军, 郑海燕, 朱亚兰. 血清同型半胱氨酸,尿酸,超敏C反应蛋白水平与腔隙性脑梗死患者颈动脉粥样硬化程度的关系探讨[J]. 实用医院临床杂志, 2020, 17(2):220-223.
[5] 中华医学会老年医学分会,高龄老年冠心病诊治中国专家共识写作组. 高龄老年冠心病诊治中国专家共识[J]. 中华老年医学杂志, 2016, 35(7):683-691.
[6] FERENCIK M, MAYRHOFER T, BITTNER D O, et al. Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: a secondary analysis of the promise randomized clinical trial[J]. JAMA Cardiol, 2018, 3(2):144-152.
[7] GALAL H, RASHID T, ALGHONAIMY W, et al. Detection of positively remodeled coronary artery lesions by multislice CT and its impact on cardiovascular future events[J]. Egypt Heart J, 2019, 71(1):26-26.
[8] 郝家明. 血清TBIL、Lp(a)和CysC检测在冠心病诊断中的临床价值[J]. 中国热带医学, 2015, 15(8):977-980.
[9] 董茜, 韩晓涛, 陈永福, 等. 不同类型冠心病患者血清Hcy、TBIL、hs-CRP、尿酸的表达及临床意义[J]. 现代生物医学进展, 2020, 20(9):79-82.
[10] 张云红, 赵义娟, 沙敏, 等. 老年原发性高血压患者颈动脉粥样硬化斑块与血清标志物之间的相关性分析[J]. 中华老年心脑血管病杂志, 2018, 20(4):374-377.
[11] BADIMON L, PEÑA E, ARDERIU G, et al. C-reactive protein in atherothrombosis and angiogenesis[J]. Front Immunol, 2018, 2(9):430-430.
[12] 孔勇, 王莹, 刘海超, 等. 血清同型半胱氨酸在脑梗死急性期及颈动脉粥样硬化斑块形成中的作用[J]. 中国临床保健杂志, 2018, 21(6):45-48.
[13] 魏群,周萍.老年高血压患者颈动脉粥样硬化与血清同型半胱氨酸、脂蛋白(a)、尿酸的关系[J]. 实用老年医学, 2016, 30(6):490-492.
[14] 张静, 陈宏勃, 邢玥, 等. 应用血管内视镜观察不稳定性动脉斑块的形成及其与冠心病危险因素的关系[J]. 中国介入心脏病学杂志, 2006, 14(2):127-127.

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