血清生化指标与冠心病患者冠状动脉狭窄程度的相关性  

Correlation between serum biochemical parameters and the degree of coronary artery stenosis in patients with coronary heart disease

作　　者：王蓓丽 李辉军 伍严安[3] 戴婉如[3] 李懿皞 郭玮 潘柏申 WANG Beili;LI Huijun;WU Yan'an;DAI Wanru;LI Yihao;GUO Wei;PANBaishen(Department of Clinical Laboratory,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Clinical Laboratory,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;Department of Clinical Laboratory,Fujian Provincial Hospital,Fuzhou 350001,Fujian,China)

机构地区：[1]复旦大学附属中山医院检验科,上海200032 [2]华中科技大学同济医学院附属同济医院检验科,湖北武汉430030 [3]福建省立医院检验科,福建福州350001

出　　处：《检验医学》2020年第1期6-10,共5页Laboratory Medicine

基　　金：国家自然科学基金项目（81572064）;国家自然科学基金项目（81772263）;国家自然科学基金项目（81972000）;国家自然科学基金青年项目（81902139）;上海市卫生计生系统重要薄弱学科建设项目（2015ZB0201）;上海市卫生健康委员会上海市临床重点专科项目;上海青年临床医技人才（临床检验专业）培养资助计划项目（沪医卫基〔2018〕02号）;复旦大学附属中山医院临床研究专项基金资助项目（2018ZSLC05）

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(apo B)、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。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 lipoproteincholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),lipoprotein(a)[Lp(a)],apolipoproteinA1(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 arterystenosis. 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 showedthat Alb decreasing,AST increasing,FPG increasing,HDL-C decreasing,Lp(a) increasing and male were riskfactors 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 arterystenosis in patients with coronary heart disease,and they can be used for preliminary judgment. Whether AST,Alb andHDL-C can be used as the predictors of coronary artery stenosis re

关 键 词：生化指标 GENSINI积分 经皮冠状动脉介入术 冠心病 

分 类 号：R446.1[医药卫生—诊断学]