| Background: Coronary heart disease has become a threat to human survival and health of serious diseases. In recent years, with people's living patterns and changes in the living environment and the world's population ageing process, coronary heart disease morbidity and mortality increase with day by day. How to access the effective prevention and treatment of coronary heart disease has become the hot topic in the Community Medicine. With the in-depth development of coronary heart disease research and awareness, the diagnosis and treatment of coronary heart disease has made considerable progress , and the people's health status can be improved. But it is still not possible to fundamentally change the situation that the masses of patients still bear the suffering of the chronic diseases and heavy financial burden. How to better solve the problem that set a great challenge to the broad masses of medical workers. As we all know, many factors of coronary heart disease is the result of the role. Multiple factors of coronary heart disease has determined that the complexity of the pathogenesis of it. Since Framingham made the concept of"Risk Factors",The studing with the risk factors of coronary heart disease has become very active research field. So far there may be more than 300 kinds of risk factors which are considered to be related to coronary heart disease have been proposed. Some of them have been widely recognized as a classic risk factors: hypertension, hyperlipidemia, smoking, diabetes, gender, age and family history of coronary heart disease, which help to reveal the pathogenesis of coronary heart disease as a role in adding fuel to the flames, and through the intervention and control of these risk factors has effectively influence the occurrence and development of coronary heart disease . In recent years a large number of epidemiological and more and more research shows that blood uric acid and bilirubin are associated with coronary heart disease. This makes the two biochemical indicators which are not recognized as the clinical significance before receive wide attention. It can be imagined that if this correlation between serum uric acid,bilirubin and coronary heart disease can be confirmed and be applied, then for the diagnosis, treatment and prognosis estimate of coronary heart disease ,it will provide tow cheap and convenient Indicators.Objective: With the initial clinical studies of association between the serum bilirubin,uric acid and coronary heart disease, it would help to reveal the etiology of coronary heart disease and improve the diagnosis and treatment of coronary heart disease by a new reference indicator.Methods: Select 123 patients that underwent coronary angiography (CAG) in the Second Clinical Hospital Of Ji Lin University from June 2006 to September 2007 for study object。According to the results of CAG, All the cases were classified as CHD group and non-CHD group. The diagnostic criteria for coronary heart disease:at least one major coronary artery or its branches≥50% stenosis of CHD, and <50% non-CHD. According to the scope and count of the sick coronary artery,The CHD group was divided into single-vessel group and multi-lesion group of two subgroups。Early the next morning from going into the hospital , all the cases provided venous blood after 12 hours of fasting。then all the samples were test for serum bilirubin,uric acid and blood-fat。Ask in detail about history, calculate the index of smoking and body mass index, record the blood pressure,gender and age。According to the result of CAG, coronary severity scores (CCS) was applied to estimate severity of coronary artery disease. Application of T-test, chi-square test, linear correlation analysis and multiple stepwise regression analysis of data for processing。Results:①The two–sample test for independent samples showed that The level of TBIL and DBIL in group CHD are lower than those in non-CHD group(P<0.05), whereas there was no difference of IBIL between two groups(P > 0.05)。The level of SUA in group CHD is higher than this in non-CHD group(P<0.05)。Between the two subgroups of CHD, the statistical result showed that the level of TBIL and DBIL in multi-lesion group are lower than those in single-vessel group and non-CHD group(P<0.05);The level of SUA in multi-lesion group is higher than this in single-vessel group and non-CHD group(P<0.05)。②Linear correlation analysis reveal that both TBIL and DBIL have negative correlation with LNCCS, r=–0.382 (P<0.01) and r=–0.563(P<0.01) respectively。Whereas SUA has positive correlation with LNCCS, r=0.147(P<0.01)。③multiple stepwise regression analysis showed that DBIL,SUA,LDL-C,GENDER,AGE,BMI,SQRTSMOKING enter regression equation。It reveal that the SUA have no notable association with LNCCS(P=0.074)。The regression equation is: LNCCS=1.067-0.476 DBIL +0.216 LDL-C+0.169 B I M+ 0.232 A G E+0.483-A G E+0021 SMOKING R=0.783, R~2=0.613, R~2adj=0.536④The association between DBIL,SUA and the other risk factors of CHD is analysed by multiple stepwise regression analysis showed the regression equation is: DBIL=8.647-0.461LDL-C-0.637GENDER-0.031AGE R=0.488, R~2=0.238, R~2adj=0.306 SUA=2.374+0.463LDL-C+0.013AGE+0.251BMI R=0.836, R~2=0.699, R~2adj=0.377Conclusion: Serum bilirubin level have a negative correlation with the severity of coronary heart disease。The low serum bilirubin level is an independent risk factor for CHD。Bilirubin is a powerful endogenous of antioxidants, which can inhibit lipid peroxidation and the formation of oxygen free radicals, scavenge oxygen free radical , suppress the immune response and inflammation process。It may be played against atherosclerosis (AS), in order to provide an important protection against the incidence and process of coronary artery disease (CAD), which plays a protective role to body。The physiological characteristics of Serum Bilirubin has opened up a new line of thought for the prevention and treatment of CHD。The association of bilirubin and severity of coronary artery disease also has a certain value in clinic, by analyzing bilirubin concentration and other risk factors of CHD, it is helpful to estimate the severity of coronary artery disease and make more reasonable therapy plan. As for which present form of bilirubin has more powerful antioxidant capacity and what's the role the metabolism system of bilirubin played in the process of fighting against AS are pending further study. Serum uric acid concentration is positively correlated with the severity of coronary artery disease . Hyperuricemia is the risk factors of CHD, but while introducing the other risk factors of CHD, The correlation between serum uric acid and CHD became not significant in multivariate analysis. Thus serum uric acid is not an independent risk factor of CHD. Serum uric acid plays the dual role of antioxidants and oxidants in the body. It may be given a different meaning of excess SUA levels while under different circumstances. While in population samples at relatively low risk of CVD, SUA is at best a very weak predictor of CVD, by contrast it is a significant independent predictor among subjects at high or very high risk.. This could be inferred, the relevance between serum uric acid and CHD relies more heavily on the other risk factors of CHD in the degree of complexity. It indicates that uric acid should be viewed more likely as a biological marker reflecting other causative parameters. Aft all, how is the existence of a causal relationship between the serum uric acid and CHD, as well as whether serum uric acid is a predictor or even a causative factor of CVD has yet to be studied further. |
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