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目的探讨血清尿酸(UA)及胆红素水平与冠状动脉易损斑块之间的关系。方法选取300例行冠状动脉造影确诊的冠心病患者及60例冠状动脉造影正常者(对照组),根据狭窄的冠状动脉斑块形态将冠心病患者进行分组:Ⅰ型斑块组(85例)、Ⅱ型斑块组(139例)和Ⅲ型斑块组(76例)。测定4组受检者的血清UA、总胆红素(TBiL)、直接胆红素(DBiL)及血脂水平。结果与对照组、Ⅰ型斑块组和Ⅲ型斑块组比较,Ⅱ型斑块组患者血清低密度脂蛋白胆固醇(LDL-C)、UA水平显著升高(P<0.01),TBiL、DBiL水平显著降低,差异有统计学意义(P<0.05);Ⅱ型斑块组UA水平与LDL-C、TC水平呈正相关(P<0.05),而TBiL及DBiL与UA及血脂指标之间不存在相关性;LDL-C、UA、TBiL和DBiL是斑块稳定性的独立危险因素(P均<0.05),其相对危险度(RR,用OR值代替)分别为5.408、2.610、2.059和1.330。结论血清UA和胆红素水平可以反映冠状动脉粥样硬化斑块的稳定性,UA水平增高或胆红素水平降低与急性冠状动脉事件的发生密切相关。
Objective To investigate the relationship between serum uric acid (UA), bilirubin and vulnerable plaque in coronary artery. Methods Three hundred and fifty patients with coronary heart disease confirmed by coronary angiography and 60 patients with normal coronary arteries (control group) were selected. Patients with coronary heart disease were divided into two groups based on the plaque morphology: type Ⅰ plaque group (n = 85) , Type Ⅱ plaque group (139 cases) and type Ⅲ plaque group (76 cases). Four groups of subjects were measured serum UA, total bilirubin (TBiL), direct bilirubin (DBiL) and blood lipid levels. Results Compared with the control group, type Ⅰ plaque group and type Ⅲ plaque group, the levels of serum LDL-C and UA were significantly increased in type Ⅱ plaque group (P <0.01), but TBiL and DBiL (P <0.05). There was a positive correlation between UA level and level of LDL-C and TC in type Ⅱ plaque (P <0.05), but no correlation between TBiL, DBiL and UA and level of serum lipids LDR-C, UA, TBiL and DBiL were independent risk factors for plaque stability (all P <0.05). The relative risk (RR, OR) was 5.408, 2.610, 2.059 and 1.330 respectively. Conclusions Serum UA and bilirubin levels can reflect the stability of coronary atherosclerotic plaque. UA level or bilirubin levels are closely related to acute coronary events.