【摘要】 目的探讨血清生化指标与冠心病患者冠状动脉狭窄程度的相关性。方法选取上海市、武汉市和福州市3家三级甲等综合性医院临床诊断为冠心病且接受冠状动脉造影检查的患者574例,记录患者在经皮冠状动脉介入治疗(PCI)术中得到的冠状动脉狭窄程度数据,量化后计算Gensini积分,同时收集患者临床资料并检测血清生化指标,项目包括总胆红素(TB)、直接胆红素(DBil)、总蛋白(TP)、白蛋白(Alb)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、乳酸脱氢酶(LDH)、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(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)]、载脂蛋白A1(apo A1)、载脂蛋白B(apoB)、高敏C反应蛋白(hs-CRP)。采用Logistic回归分析评估各项指标与冠状动脉狭窄程度的相关性。结果高Gensini积分组男性所占比例及TP、Alb、ALT、AST、FPG、HDL-C、Lp(a)、apo A1、apo B、hs-CRP水平与低Gensini积分组比较,差异均有统计学意义(P<0.05)。其他项目2个组之间差异均无统计学意义(P>0.05)。Logistic回归分析结果显示,Alb降低、AST升高、FPG升高、HDL-C降低、Lp(a)升高及男性为冠状动脉狭窄程度增加的危险因素[比值比(OR)值分别为0.932、1.011、1.121、0.299、1.015、1.753,95%可信区间(CI)分别为0.886～0.98、1.002～1.02、1.024～1.227、0.143～0.624、1.002～1.008、1.110～2.767]。结论 FPG和Lp(a)是预测冠心病患者冠状动脉狭窄程度的重要风险因素,可用于冠心病患者冠状动脉病变情况的初步判断。AST、Alb和HDL-C能否作为冠状动脉狭窄程度的预测指标仍需进一步研究。更多还原

【Abstract】 Objective To investigate the correlation between serum biochemical parameters and the degree of coronary artery stenosis in patients with coronary heart disease. Methods A total of 574 patients with coronary heart disease undergoing coronary angiography were enrolled from 3 Grade A Class 3 hospitals in Shanghai,Wuhan and Fuzhou. The coronary artery stenosis data obtained during percutaneous coronary intervention(PCI)were recorded and quantified to calculate Gensini score. Clinical data and the results of serum biochemical parameters,including total bilirubin(TB),direct bilirubin(DBil),total protein(TP),albumin(Alb),alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyltransferase(GGT),lactate dehydrogenase(LDH),fasting plasma glucose(FPG),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),lipoprotein(a)[Lp(a)],apolipoprotein A1(apo A1),apolipoprotein B(apo B) and high-sensitivity C-reactive protein(hs-CRP),were collected. Logistic regression analysis was used to assess the correlation between each parameter and the degree of coronary artery stenosis. Results Compared to low Gensini score group,the proportion of males and TP,Alb,ALT,AST,FPG,HDL-C,Lp(a),apo A1,apo B,hs-CRP levels in high Gensini score group had statistical significance(P<0.05),while the other parameters had no statistical significance(P>0.05). Logistic regression analysis showed that Alb decreasing,AST increasing,FPG increasing,HDL-C decreasing,Lp(a) increasing and male were risk factors for coronary artery stenosis [odds ratios(OR) were 0.932,1.011,1.121,0.299,1.005 and 1.753;95% confidence intervals(CI) were 0.886-0.980,1.002-1.020,1.024-1.227,0.143-0.624,1.002-1.008 and 1.110-2.767,respectively]. Conclusions FPG and Lp(a) are risk factors for predicting the degree of coronary artery stenosis in patients with coronary heart disease,and they can be used for preliminary judgment. Whether AST,Alb and HDL-C can be used as the predictors of coronary artery stenosis remains to be further studied.更多还原