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目的探讨血浆纤维蛋白原、血清胆红素和尿酸与冠状动脉轻度狭窄的相关性。方法将2007年4月至2009年5月于我科就诊的疑似心肌缺血患者,根据冠状动脉造影结果分为冠状动脉轻度狭窄组和正常对照组,并采用logistic回归分析冠状动脉轻度狭窄的危险因素。结果共纳入279例患者,其中冠状动脉轻度狭窄组191例,正常对照组88例。两组在性别、年龄、高血压病、糖尿病、吸烟史、入院时肱动脉收缩压、纤维蛋白原和肌酐上差异均有统计学意义。多因素logistic回归分析提示:冠状动脉轻度狭窄与年龄[OR=1.084,95%CI(1.040,1.129),P<0.001]、高血压病[OR=3.025,95%CI(1.462,6.261),P=0.003]、糖尿病[OR=2.519,95%CI(1.066,5.951),P=0.035]、吸烟史[OR=5.412,95%CI(2.186,13.401),P<0.001]和纤维蛋白原[OR=1.748,95%CI(1.059,2.885),P=0.029]呈正相关,与直接胆红素[OR=0.599,95%CI(0.418,0.858),P=0.005]和高密度脂蛋白[OR=0.219,95%CI(0.049,0.985),P=0.048]呈负相关。两组血清尿酸水平差异无统计学意义,多因素分析也未证实血清尿酸与冠状动脉轻度狭窄存在相关性。结论除年龄、高血压病、糖尿病、吸烟史和高密度脂蛋白降低等传统危险因素外,血浆纤维蛋白原升高和血清直接胆红素降低也是冠状动脉轻度狭窄的独立危险因素,而血清尿酸水平与之相关性不显著,提示在临床工作中应注意结合传统危险因素、纤维蛋白原和胆红素的检查,有针对性地筛选早期冠状动脉粥样硬化患者,加强二级预防。
Objective To investigate the correlation between plasma fibrinogen, serum bilirubin and uric acid and mild coronary stenosis. Methods Patients with suspected myocardial ischemia treated in our department from April 2007 to May 2009 were divided into mild coronary artery stenosis group and normal control group according to coronary angiography results and logistic regression was used to analyze the mild coronary stenosis Risk factors. Results A total of 279 patients were enrolled, including 191 cases of mild coronary stenosis group and 88 cases of normal control group. There were significant differences between the two groups in gender, age, hypertension, diabetes, smoking history, brachial artery systolic pressure, fibrinogen and creatinine on admission. Multivariate logistic regression analysis showed that mild coronary stenosis was associated with age (OR = 1.084,95% CI 1.040,1.129, P <0.001), hypertension (OR 3.025, 95% CI 1.462, 6.261) P = 0.003], diabetes [OR = 2.519,95% CI (1.066,5.951), P = 0.035], smoking history [OR = 5.412,95% CI (2.186,13.401), P <0.001] and fibrinogen [ OR = 1.748,95% CI 1.059,2.885, P = 0.029], which was positively correlated with direct bilirubin [OR = 0.599,95% CI (0.418,0.858), P = 0.005] and high density lipoprotein = 0.219, 95% CI (0.049, 0.985), P = 0.048]. There was no significant difference in serum uric acid levels between the two groups. Multivariate analysis also did not confirm the correlation between serum uric acid and mild coronary stenosis. Conclusion In addition to traditional risk factors such as age, hypertension, diabetes, smoking history and high density lipoprotein lowering, elevated plasma fibrinogen and decreased serum direct bilirubin are also independent risk factors for mild coronary stenosis. Serum Uric acid level was not significant correlation, suggesting that in clinical work should pay attention to the combination of traditional risk factors, fibrinogen and bilirubin examination, targeted screening of patients with early coronary atherosclerosis, and strengthen secondary prevention.