血清胆红素水平与冠脉支架植入术后患者冠脉事件复发的相关性研究  

Correlation between Serum Bilirubin and Recurrent Coronary Events in Patients after Coronary Artery Stent Implantation

作　　者：罗承锋[1] 柴仁杰[1] 李爱群[1] 成传访[1] 黄鹤[1] 林晓圳[1] 莫沛[1] 李国强[1] 李晓云[1] 熊龙根[1] 

机构地区：[1]广州医科大学附属第二医院广州心血管疾病研究所,广州510260

出　　处：《中国循证医学杂志》2014年第8期905-910,共6页Chinese Journal of Evidence-based Medicine

基　　金：广东省科技计划资助项目(编号:2010B031600140)

摘　　要：目的研究导致患者冠脉支架植入术后冠脉事件复发的相关危险因素。方法回顾性分析2012年1月至2013年6月在广州医科大学附属第二医院心内科行冠状动脉造影术(coronary angiography,CAG)或复查CAG住院患者的临床资料。所有患者均曾因冠心病在我院行冠脉支架植入术且有完整的CAG影像资料以及其他相关临床资料。根据患者临床资料及CAG影像资料,将患者分为冠脉事件组与无冠脉事件组。统计分析使用SPSS 16.0软件,并用logistic回归模型对危险因素进行多因素分析。结果共纳入115例患者,其中发生冠脉事件组50例,未发生冠脉事件组65例。发生冠脉事件组患者的基线水平及复查CAG时的血清总胆红素、非结合胆红素水平均明显低于无冠脉事件组(P<0.05或P<0.01)。冠脉病变加重需血运重建患者的基线血清总胆红素水平及复查CAG时血清总胆红素、非结合胆红素水平均显著低于无冠脉病事件的患者(P<0.05或P<0.01);支架内再狭窄患者的基线及复查CAG时血清非结合胆红素水平均显著低于无冠脉事件的患者(P<0.05)。对冠脉支架植入术后患者的基线资料及复查时的临床资料进行二分类logistic向前逐步回归分析,结果发现多支血管病变[二支病变:OR=10.094,95%CI(2.498,40.798),P=0.001;三支病变:OR=16.047,95%CI(4.121,62.481),P=0.000]、复查时低血清非结合胆红素水平[OR=0.873,95%CI(0.773,0.987),P=0.03]均是冠脉事件发生的独立危险因素。结论多支血管病变以及复查时低血清非结合胆红素水平是冠脉支架植入术后患者冠脉事件复发的独立危险因素。Objective To investigate the factors related to recurrent coronary events in patients after coronary artery stent implantation. Methods We retrospectively studied the patients performing coronary angiography （CAG） who were admitted to the Department of Cardiology of the Second Affiliated Hospital of Guangzhou Medical University between January 2012 and June 2013. All of the enrolled patients had received CAG in our hospital, with complete coronary angiogram and clinical data. The patients were divided into two groups according to the coronary angiogram and clinical data： coronary event group and non-coronary event group. SPSS 16.0 software was employed for statistical analysis, and multivariate analysis was performed using binary logistic regression model to analyze the risk factors. Results A total of 115 patients were included, of which 50 patients had recurrent coronary events. Both the serum total bilirubin and uncon）ugated bilirubin in patients with coronary events were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination （P〈0.05 or P〈0.01）. The serum total bilirubin at baseline and the serum total bilirubin and uncon）ugated bilirubin at the time of CAG reexamination were significantly lower in patients with revasculization due to the progression of coronary artery lesions compared with the patients without coronary events （P〈0.05 or P〈0.01）. The serum uncon）ugated bilirubin in patients with in-stent restenosis were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination （P〈0.05）. The results of logistic regression analysis showed that multi-vessel coronary artery disease （two-vessel coronary artery disease： OR= 10.094, 95%CI 2.498 to 40.798, P=0.001; three-vessel coronary artery disease： OR= 16.047, 95%CI 4.121 to 62.481, P=0.000） and low serum unconjugated bilirubin （OR=0.873, 95%CI 0.773 to 0.987, P=0.03） were independent risk fact

关 键 词：冠状动脉疾病 冠状动脉支架植入术 胆红素 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]