急性冠脉综合征患者血胆红素、纤维蛋白原、脂蛋白(a)的变化及与冠脉病变程度的关系

Objective: To investigate the changes of serum total bilirubin (TBil), serum direct bilirubin (DBil), serum indirect bilirubin (IBil), plasma fibrinogen (Fib) and serum lipoprotein (a) [ Lp (a) ] and association of the severity of coronary artery lesion and them in patients with acute coronary syndromes (ACS). Methods: 30 patients with acute myocardial infarction (AMI group), 38 patients with unstable angina pectoris (UAP group) and 23 patients with stable angina pectoris (SAP group) were studied, and 28 coronary angiography negative subjects were taken as controls (control group). The serum Bil, plasma Fib and serum Lp (a) were measured respectively. The levels of them in 4 groups and association of the severity of coronary artery lesion and them were analyzed. Results: ①Compared with control group, the levels of TBil, DBil and IBil among AMI group, UAP group and SAP group were significantly lower (P＜0.01), and the levels of them in AMI group were significantly lower than them in SAP group (P＜0.05), but compared with UAP group, there were no significant difference (P＞0.05). The levels of TBil in UAP group was significantly lower than it in SAP group (P＜0.05), but the levels of DBil and IBil were no significant difference (P＞0.05). The levels of Fib in AMI group was significantly higher than it in UAP group, SAP group and control group (P＜0.01), but the levels of Fib among UAP group, SAP group and control group were no significant difference (P＞0.05). The levels of Lp (a) among four groups were no significant difference (P＞0.05). ②The levels of TBil, DBil and IBil in triple branch lesions group was significantly lower than them in single branch lesion group (P＜0.05), but compared with double branch lesions group, there were no significant difference (P＞0.05). The levels of DBil in double branch lesions group was significantly lower than them in single branch lesion group (P＜0.05), but the levels of TBil and IBil were no significant difference (P＞0.05). The levels of Fib in triple branch lesions group was significantly higher than them in double branch lesions group and single branch lesion group (P＜0.05), but the levels of Fib in single branch lesion group and double branch lesions group were no significant difference (P＞0.05). The levels of Lp (a) among single branch lesion group, double branch lesions group and triple branch lesions group were no significant difference (P＞0.05). ③Spearman correlation analysis showed: scores of coronary artery lesion were negatively related to the levels of TBil, DBil and IBil, and positively related to history of diabetes mellitus (DM) and the levels of Fib (spearman r: -0.311、-0.210、-0.311、0.299、0.335, P＜0.05). Stepwise multiple linear regression showed that TBil, history of DM and Fib were associated with scores of coronary artery lesion. Conclusion: The levels of reduced Bil and elevated Fib are closely related with ACS and the severity of coronary artery lesion, but the levels of Lp (a) may be not related with them.