冠心病患者血清总胆汁酸水平与冠状动脉病变严重程度的相关性研究

发布时间：2018-08-24 20:10

【摘要】：研究背景:冠状动脉粥样硬化性心脏病(冠心病coronary heart disease,CHD)已经成为威胁人类健康的主要疾病之一。目前大量研究表明血脂异常,尤其总胆固醇(total cholesterol,TC)和低密度脂蛋白胆固醇(low density lipoprotein-cholesterol LDL-C)升高是CHD最主要的危险因素之一,强化调脂治疗可以使CHD患者明显获益。目前调脂药物的主要作用机制是抑制胆固醇的合成或吸收。而胆固醇代谢去路异常同样可以使TC和LDL-C升高,胆固醇在体内的主要代谢去路是通过转化为胆汁酸随胆汁排出体外,国内有研究提示血清总胆汁酸(total bile acid,TBA)水平与CHD相关,但TBA水平与冠状动脉病变程度有无相关性尚少有研究,如果有证据表明TBA水平与冠状动脉病变程度相关,临床将多一项预测冠脉病变程度的指标,同时为CHD的防治提供新思路。目的:探讨CHD患者TBA水平与冠状动脉病变严重程度的相关性,进一步探寻评估冠状动脉病变严重程度的临床指标,为防治冠状动脉病变提供新的思路。方法:选取经冠状动脉造影(coronary angiography,CAG)检查确诊的CHD患者120例为冠心病组;选取经CAG检查除外冠心病的患者60例为对照组。收集两组患者血清TBA水平及冠心病组CAG结果。采用Gensini评分系统对CHD患者CAG结果进行评分。两组间血清TBA水平比较采用独立样本t检验,采用Pearson相关分析检测CHD患者血清TBA水平与Gensini评分的相关性。采用logistic回归分析CHD的多重危险因素。结果:冠心病组血清TBA水平明显高于对照组(4.92±2.22)VS(3.01±1.89)umol/L,P0.05;Pearson相关分析显示冠心病患者血清TBA水平和Gensini评分有明显相关性(r=0.67,P0.05)。进一步以TBA4.0umol/L和TBA≥4.0umol/L为二分变量,应用二分类logistic回归分析调整了心血管危险因素后,结果显示TBA≥4.0umol/L是CHD的独立危险因素(OR:2.31,95%CI:1.13~4.69,P0.05)。结论:冠心病患者血清TBA水平与冠状动脉病变严重程度密切相关,TBA水平升高可能是CHD的危险因素,TBA水平可作为预测冠状动脉病变严重程度的指标,干预胆汁酸代谢有可能成为预防和治疗CHD的新途径。
[Abstract]:Background: coronary atherosclerotic heart disease (coronary heart disease,CHD) has become one of the major diseases threatening human health. At present, a large number of studies have shown that dyslipidemia, especially the increase of total cholesterol (total cholesterol,TC) and low density lipoprotein cholesterol (low density lipoprotein-cholesterol LDL-C), is one of the most important risk factors for CHD. Intensive lipid regulation therapy can significantly benefit CHD patients. At present, the main mechanism of lipid-regulating drugs is to inhibit the synthesis or absorption of cholesterol. The abnormal metabolic pathway of cholesterol can also increase TC and LDL-C. The main metabolic pathway of cholesterol in vivo is by transforming bile acid out of the body. Domestic studies have suggested that the level of serum total bile acid (total bile acid,TBA is related to CHD. However, there are few studies on the correlation between TBA level and coronary artery lesion degree. If there is evidence that TBA level is related to coronary artery lesion degree, there will be a new index to predict coronary artery lesion degree in clinic, and a new idea for the prevention and treatment of CHD will be provided at the same time. Objective: to explore the correlation between the level of TBA and the severity of coronary artery disease in patients with CHD, and to explore the clinical indexes to evaluate the severity of coronary artery disease, so as to provide a new idea for the prevention and treatment of coronary artery disease. Methods: 120 patients with CHD diagnosed by coronary angiography (coronary angiography,CAG) were selected as coronary heart disease group, and 60 patients who were excluded from coronary heart disease by CAG were selected as control group. The level of serum TBA and the results of CAG in coronary heart disease group were collected. The CAG results of CHD patients were evaluated by Gensini scoring system. Serum TBA levels were compared by independent sample t-test and Pearson correlation analysis was used to detect the correlation between serum TBA level and Gensini score in patients with CHD. Multiple risk factors of CHD were analyzed by logistic regression analysis. Results: the serum TBA level in coronary heart disease group was significantly higher than that in control group (4.92 卤2.22) VS (3.01 卤1.89) umol/L,P0.05;Pearson correlation analysis showed that there was a significant correlation between serum TBA level and Gensini score in patients with coronary heart disease (P 0.05). Furthermore, with TBA4.0umol/L and TBA 鈮，

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