| Objective: Accompanied with the gradual improvement of the life quality,people are paying more attention to cardiovascular and cerebravascular diseases,whose incidence rates have grown rapidly in recent years.Carotid artery is a representative of the whole body blood vessels,of which detection method is simple,easy to manipulate,and representative.The measurement of carotid intima-media thickness can reflect the degree of a systemic vascular atherosclerosis,which is an appropriate index for evaluating the degree of atherosclerosis.Recent studies have indicated that bilirubin has played an important role in the development of carotid artery atherosclerosis,but the conclusion is not consistent,therefore,We will explore physical examination from a large sample of bilirubin level and the correlation of carotid artery lesions,and analyze the related factors,further understanding the mechanism between the two.Method:3000 cases for health check-up in physical examination center in Hebei General Hospital were recruited.All subjects were divided into two groups according to the carotid intima-media thickness(IMT)by ultrasound:the non-plaque group(IMT<1.3 mm)and plaque group(IMT?1.3 mm).Bilirubin,blood lipids,uric acid,liver and kidney function index and other indicators were detected using automatic biochemical analyzer.Result:1 Comparison of clinical characteristics between non-plaque group and plaque group Age,sex,bilirubin,liver function,uric acid,creatinine,fasting blood glucose,blood lipids and other indicators were compared between non-plaque and plaque group using two independent sample t-test or nonparametric test.The total bilirubin and direct bilirubin were significant lower in plaque group than those in non-plaque group(total bilirubin: 13.59±4.38 mmol/L vs.15.41±5.00 mmol/L,P<0.01;direct bilirubin: 3.77±1.35 mmol/L vs.4.39±1.54 mmol/L,P <0.01).The indirect bilirubin was significant higher in plaque group than that in non-plaque group(7.79±7.42 mmol/L vs.3.14±5.49 mmol/L,P <0.01).The age in plaque group was lower than that in non-plaque group(P <0.01).Compared with the non-plaque group,the creatinine,aspertate aminotransferase(AST),blood glucose,total cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)were significant higher in the plaque group,while the high density lipoprotein cholesterol(HDL-C)was lower(P <0.01).There was no statistical significance in uric acid,alanine aminotransferase(ALT),glutamyl transpeptidase(GGT)between two groups.2 Correlation analysis between bilirubin and clinical characteristicsCorrelation analysis between total bilirubin,direct bilirubin,indirect bilirubin and age,uric acid,creatinine,hepatic function,TC,TG and LDL-C,blood glucose was conducted using Spearman correlation,respectively.Total bilirubin was in negative correlation with GGT,Tc and TG,while in positive correlation with age,uric acid,creatinine,ALT,AST,blood glucose and HDL-C(P <0.01).Direct bilirubin was in negative correlation with GGT,TC,TG and LDL-C,while in positive correlation with age,uric acid,creatinine,ALT,AST,HDL-C,blood glucose(P <0.01).Indirect bilirubin level was in negative correlation with age and blood glucose,while in positive correlation with GGT,AST,TC,TG,HDL-C and LDL-C.3 Correlation analysis between total bilirubin level and incidence of carotid artery atherosclerosisThe median of total bilirubin was 14.0 in all subjects.Based on the quartile of total bilirubin,all patients were divided into four groups:?11.3 mmol/L,Q2:11.4-14.0 mmol/L,Q3:14.1-17.5 mmol/L and Q4?17.6 mmo/L.The prevalence of carotid artery atherosclerosis was 59% in Q1,46% in Q2,43% in Q3 and 37% in Q4,respectively.Chi-square analysis showed the prevalence of carotid artery atherosclerosis was significant lower in Q2(OR:0.585,95%CI:0.479-0.714),Q3(OR:0.529,95%CI:0.432-0.648)and Q4(OR:0.409,95%CI:0.333-0.503)than that in Q1.Taking Q1 as the control group,logistic regression analysis showed the prevalence of carotid artery atherosclerosis was significant lower in Q2(OR:0.821,95%CI:0.768-0.856),Q3(OR:0.809,95%CI:0.751-0.832)and Q4(OR:0.780,95%CI:0.735-0.813)than that in Q1.After adjusting sex and age,the prevalence of carotid artery atherosclerosis was still lower in Q2(OR:0.802,95%CI:0.758-0.848),Q3(OR:0.864,95%CI:0.836-0.893)and Q4(OR:0.899,95%CI:0.882-0.916)when compared with Q1.Further adjusting with indirect bilirubin,uric acid,serum creatinine,GGT,ALT,AST,blood glucose,TC,TG,HDL-C and LDL-C,the results above were still existed,with the OR and 95%CI as follows:(OR:0.816,95%CI:0.769-0.867)for Q2,(OR:0.861,95%CI:0.829-0.894)for Q3 and(OR:0.893,95%CI:0.874-0.912)for Q4.4 Correlation analysis between direct bilirubin level and incidence of carotid artery atherosclerosisThe median of total bilirubin was 3.9 in all subjects.Based on the quartile of total bilirubin,all patients were divided into four groups:?3.1 mmol/L,Q2:3.2-3.9 mmol/L,Q3:4.0-5.0 mmol/L and Q4?5.1 mmo/L?The prevalence of carotid artery atherosclerosis was 73% in Q1,57% in Q2,56% in Q3 and 45% in Q4,respectively.Chi-square analysis showed the prevalence of carotid artery atherosclerosis was significant lower in Q2(OR:0.503,95%CI:0.408-0.620),Q3(OR:0.473,95%CI:0.383-0.584)and Q4(OR:0.313,95%CI:0.253-0.387)than that in Q1.Taking Q1 as the control group,logistic regression analysis showed the prevalence of carotid artery atherosclerosis was significant lower in Q2(OR:0.517,95%CI:0.427-0.602),Q3(OR:0.490,95%CI:0.410-0.588)and Q4(OR:0.469,95%CI:0.381-0.567)than that in Q1.After adjusting sex and age,the prevalence of carotid artery atherosclerosis was still lower in Q2(OR:0.433,95%CI:0.360-0.521),Q3(OR:0.566,95%CI:0.506-0.632)and Q4(OR:0.506,95%CI:0.610-0.698)when compared with Q1.Further adjusting with indirect bilirubin,uric acid,serum creatinine,GGT,ALT,AST,blood glucose,TC,TG,HDL-C and LDL-C,the results above were still existed,with the OR and 95%CI as follows:(OR:0.480,95%CI:0.387-0.594)for Q2,(OR:0.606,95%CI:0.532-0.689)for Q3 and(OR:0.532,95%CI:0.634-0.745)for Q4.Conclusions:1 In healthy check-up crowd,the normal range of total bilirubin and direct bilirubin were negatively correlated with carotid artery atherosclerosis.This correlation was increased with the elevation of bilirubin level.The total bilirubin and direct bilirubin are the independent protective factors for carotid artery atherosclerosis.2 The normal range of total bilirubin and direct bilirubin were in negative correlation with TC,TG,LDL-C,while were in positive correlation with HDL-C. |
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