【摘要】：目的分析總膽紅素水平(TBil)是否為冠心病的保護(hù)性因素及對(duì)其的預(yù)測(cè)價(jià)值,同時(shí)通過(guò)分析與hs-CRP的相關(guān)關(guān)系,探討其可能的冠心病保護(hù)機(jī)制。方法選取2014年10月-2016年10月期間本院心血管心內(nèi)科住院疑診冠心病心絞痛并接受冠狀動(dòng)脈造影檢查且臨床資料完整的患者180例作為研究對(duì)象,根據(jù)造影結(jié)果分為冠心病組(n=90)與非冠心病組(n=90),分別收集其年齡、性別、體重指數(shù)(BMI)、有無(wú)高血壓病、有無(wú)糖尿病、有無(wú)吸煙史、高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)、總膽紅素(total bilirubin,TBil)、超敏C反應(yīng)蛋白(high-sensitivity C-reaction protein,hs-CRP)、谷丙轉(zhuǎn)氨酶(alanine transaminase,ALT)等臨床資料,采用logistic回歸分析探討TBil與冠心病的相關(guān)性;雙變量Pearson法分析TBil與hs-CRP的關(guān)系;通過(guò)繪制受試者工作特征曲線(receiver operating characteristic curve,ROC曲線),探討TBil對(duì)冠心病的診斷價(jià)值。結(jié)果(1)與非冠心病組相比,冠心病組TBil水平較低(P0.05),經(jīng)二元Logistic回歸分析,顯示TBil為冠心病的獨(dú)立保護(hù)性因素(P=0.001,95%CI:0.738~0.922);(2)雙變量Pearson線性分析顯示TBil與hs-CRP水平存在負(fù)相關(guān)關(guān)系(r=-0.367,P0.001);(3)經(jīng)繪制ROC曲線,TBil正確預(yù)測(cè)冠心病的界點(diǎn)值為10.35umol/L,最大ROC曲線下面積0.739(P0.01,95%CI:0.668~0.811),對(duì)應(yīng)的敏感度為0.633,特異度為0.700。結(jié)論TBil為冠心病的獨(dú)立保護(hù)性因素,低水平TBil可以作為冠心病的預(yù)測(cè)因子;TBil與hs-CRP顯著負(fù)相關(guān),提示其抗炎作用可能是其對(duì)冠心病的保護(hù)機(jī)制之一;TBil10.35umol/L可以為作為診斷冠心病的界定指標(biāo)。
[Abstract]:Objective to analyze whether total bilirubin level (TBil) is the protective factor of coronary heart disease (CHD) and its predictive value, and to explore the possible protective mechanism of coronary heart disease (CHD) by analyzing the relationship between total bilirubin and hs-CRP. Methods from October 2014 to October 2016, 180 patients with suspected angina pectoris of coronary heart disease and complete clinical data were selected. Age, sex, body mass index (BMI), hypertension, diabetes mellitus, smoking history, high density lipoprotein (high density lipoprotein,HDL) were collected. Low density lipoprotein (low density lipoprotein,LDL), total bilirubin (total bilirubin,TBil), hypersensitive C-reactive protein (high-sensitivity C-reaction protein,hs-CRP), alanine aminotransferase (alanine transaminase,ALT) and so on. Logistic regression analysis was used to investigate the correlation between TBil and coronary heart disease. The relationship between TBil and hs-CRP was analyzed by bivariate Pearson method, and the diagnostic value of TBil in coronary heart disease was discussed by drawing the (receiver operating characteristic curve,ROC curve of operating characteristic curve of subjects. Results (1) compared with the non-CHD group, the level of TBil in the CHD group was lower (P0.05). The results of binary Logistic regression analysis showed that TBil was an independent protective factor for coronary heart disease (P0. 001% 95 CI: 0.7380.922). (2) the linear analysis of bivariate Pearson showed that there was a negative correlation between TBil and hs-CRP level (r-0.367, P0.001); (3) by drawing the ROC curve, TBil correctly predicted that the threshold value of coronary heart disease was 10.35 umol / L, and the area under the maximum ROC curve was 0.739 (P0.01 ~ 95CI: 0.668 / 0.811). The sensitivity and specificity of TBil were 0.633 and 0.700 respectively. Conclusion TBil is an independent protective factor for coronary heart disease, low level TBil can be used as a predictor of coronary heart disease, TBil is negatively correlated with hs-CRP, suggesting that its anti-inflammatory effect may be one of its protective mechanisms for coronary heart disease. TBil10.35umol/L can be used as a defining indicator for the diagnosis of coronary heart disease.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4

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