2018 年第 12 期 第 13 卷

冠状动脉粥样硬化性心脏病患者血清总胆红素水平与外周动脉疾病的相关性研究

Relation between total serum bilirubin and peripheral artery disease in patients with coronary atherosclerotic heart disease

作者：王飞杨滨

英文作者：

单位：030024太原，山西省心血管病医院心内科山西省心血管病研究所

英文单位：

关键词：冠状动脉粥样硬化性心脏病；总胆红素；外周动脉疾病；踝肱指数

英文关键词：

• 摘要：

• 【摘要】目的    探讨冠状动脉粥样硬化性心脏病（冠心病）患者血清总胆红素水平与外周动脉疾病（PAD）的相关性。方法    收集2017年1月至2018年1月入住山西省心血管病医院的162例冠心病患者的病历资料，根据患者血清总胆红素检测结果分为总胆红素升高（17.2~46.2 μmol/L）组（观察组，41例）和总胆红素正常（1.7~17.1 μmol/L）组（对照组，121例）。比较2组患者性别、年龄、吸烟史和合并高血压病、糖尿病比例，血常规和血生化指标和左心室射血分数水平，以及PAD的发生率。比较PAD与非PAD患者总胆红素水平，分析冠心病患者发生PAD的危险因素。结果    观察组男性比例和血红蛋白、丙氨酸转氨酶、估算肾小球滤过率水平均高于对照组［80.5%（33/41）比71.1%（86/121）、（139±10）g/L比（130±12）g/L，（22±5）mmol/L比（18±5）mmol/L、（62±10）ml/(min·1.73 m2)比（60±14）ml/(min·1.73 m2)］，年龄、血小板计数和PAD比例均低于对照组［56（48，67）岁比57（51，64）岁、（19±3）×109/L比（21±3）×109/L、46.3%（19/41）比55.4%（67/121）］，差异均有统计学意义（均P＜0.05）。PAD患者（86例）血清总胆红素水平低于非PAD患者（76例）［11.2(5.8，18.6)μmol/L比17.2(8.9，27.4)μmol/L］，差异有统计学意义（P＜0.001）。校正混杂因素后多元Logistic回归分析发现，估算肾小球滤过率（比值比=0.76，95%置信区间：0.62~0.86，P=0.002）、总胆红素水平（比值比=0.74，95%置信区间：0.56~0.84，P＜0.001）为PAD发生的独立预测因素。结论    血清总胆红素水平与冠心病患者PAD患病率相关，可作为冠心病患者发生PAD的独立预测因子。

• 【Abstract】Objective    To explore the relation between serum bilirubin and peripheral artery disease(PAD) in patients with coronary atherosclerotic heart disease(CHD). Methods    A total of 162 CHD patients admitted to Shanxi Cardiovascular Hospital from January 2017 to January 2018 were divided into elevated total bilirubin group(observation group, 17.2-46.2 μmol/L, n=41) and normal total bilirubin group(control group, 1.7-17.1 μmol/L, n=121). Sex, age, smoking history, hypertension, diabetes, blood routine and biochemistry indexes, left ventricular ejection fraction and the prevalence rate of PAD were recorded. Serum bilirubin level was analyzed between PAD and non-PAD patients. Risk factors of PAD were analyzed by Logistic regression. Results    Male ratio, hemoglobin level, alanine aminotransferase level and estimated glomerular filtration rate（eGFR） in the observation group were higher than those in the control group［80.5%（33/41） vs 71.1%（86/121）， （139±10）g/L vs （130±12）g/L， （22±5）mmol/L vs （18±5）mmol/L， （62±10）ml/(min·1.73 m2) vs （60±14）ml/(min·1.73 m2)］; age, platelet count and PAD ratio in the observation group were lower than those in the control group［56（48，67）years vs 57（51，64）years， （19±3）×109/L vs （21±3）×109/L， 46.3%（19/41） vs 55.4%（67/121）］(all P＜0.05). Serum bilirubin level in PAD patients（n＝86） was lower than that in non-PAD patients（n＝76）［11.2(5.8，18.6)μmol/L vs 17.2(8.9，27.4)μmol/L］(P＜0.001). After adjustment of confounding factors, Logistic regression showed that eGFR（odds ratio=0.76， 95% confidence interval： 0.62-0.86， P=0.002） and total bilirubin level（odds ratio=0.74， 95% confidence interval： 0.56-0.84， P＜0.001） were independent predictive factors of PAD. Conclusion    Serum bilirubin level can be a independent predictor of PAD in CHD patients.