| Objectives Discuss the change rule of serum bilirubin level after PCI in patients and the correlation analysis between serum bilirubin level and the restenosis.To further clarify the real clinical significance of serum bilirubin indexes in patients with coronary heart disease.Methods 1 To selecte from January 2014 to September 2016 Coal General Hospital Heart Center received 258 cases of CHD patients who received PCI successfully and have complete angiographic follow-up data live as the drug-eluting stent(DES)group.To selecte 50 cases of CHD patients who only accepted coronary secondary prevention drugs(including antiplatelet drugs and statins,etc)but not had PCI treatment live as the drug therapy group.2 Using medical records query methods to collect basic information of patients in DES group,including gender,age,coronary heart disease risk factors,laboratory examination indexes,etc.The DES group were divided into two groups: ISR group(n=22)and non-ISR group(n=236)according to follow-up results.In DES group,Blood samples for serum bilirubin level were obtained before PCI,at half a month,one month,three months,six months after PCI.To collect drug therapy group patients serum bilirubin level before the drug therapy,at one month and three months after having regular medication therapy.The determination of serum bilirubin uses ELISA method in clinical laboratory of Coal General Hospital.3 All datas were collected into Excel,statistic analysis by SPSS software,analysis of variance by c 2,t-test,and the serum bilirubin level at different time by Repeated Measurement Difference Analysis.The comparison of the correlation between DBIL,IBIL and TBIL by Linear Correlation Analysis.The related factors analysis about PCI by Logistic Regression Analysis.The difference is statistically significant by P<0.05.Results 1 A total of 50 patients with drug therapy group had 12.61±2.83 ?mol/L of basis of bilirubin level before drug therapy.After having one month and three months of coronary secondary prevention drugs,their TBIL turned into 12.14±3.17 ?mol/L and11.95±2.36 ?mol/L.There was no statistically significant difference between the groups,suggesting that regular coronary secondary prevention drugs has no effect on the serum bilirubin level of human body.2 The DES group had 258 patients and they were divided into two groups: ISR group(n=22)and non-ISR group(n=236)according to follow-up results.The incidence of restenosis is 8.5%.The DES group had 161 male patients and 97 women patients.In non-ISR group,the gender composition is that 148 men(62.7%)and88 women(37.3%).That in ISR group is that 13 men(59.1%)and 9 women(40.9%).No statistical difference was found between two groups of gender composition(P=0.68>0.05).In the aspect of hypertension,heperlipemia,smoking,alcohol abuse,family history of coronary heart disease,CHD type and the number of lesion vessels,there was no statistically significant difference between ISR group and non-ISR group(P>0.05).The ISR group patients had higher incidence of diabetes than that in non-ISR group(63.6% vs30.5%)and the difference was statistically significant(P=0.007<0.05).The number of patients with not regular medication therapy in both groups were also statistically significant: 6 patients in ISR group(27.3%)vs 23 patients in non-ISR group(9.7%)(P=0.027<0.05).3 The average age of the patients of non-ISR group was 65.52±12.63 years and that in ISR group was 70.84±10.11 years.In terms of age,there was no statistically significant difference between ISR group and non-ISR group(P=0.058>0.05).Serological indicators showed that,in terms of cholesterol,triglycerides,high density lipoprotein cholesterol,low density lipoprotein,cereal third transaminase,urea nitrogen,serum creatinine,glycated hemoglobin,homocysteine,hemoglobin,total bilirubin before PCI and platelet,there was no statistically significant difference between ISR group and non-ISR group(P>0.05).However,in terms of fibrinogen,uric acid and lipoprotein-a,the differences were statistically significant(P: 0.001,0.005,0.019,respectively).4 Put the uric acid,diabetes,lipoprotein-a and fibrinogen of DES group patients into Logisric regression equation.The results showed that uric acid,diabetes,lipoprotein-a,and fibrinogen were risk factors of ISR,positively correlated with ISR(The Partial Regression Coefficient>0).5 On the repetitive measure analysis of the serum bilirubin of the DES group patients at each measurement time,the results showed that: 1)The TBIL at different measurement time were statistically significant,F(Within the group)=19.625,P=0.000.2)The change trends of the TBIL of ISR group and non-ISR group after PCI were same,with not statistical difference,F(Between groups)=5.546,P=0.08>0.05.3)There was interactions between the measurement time and the groups(ISR group and non-ISR group),F(Interaction Coefficient)=45.669,P=0.000.6 The serum bilirubin level,compared with that before PCI,showed a trend of rise.This kind of phenomenon also appeared in between non-ISR group and ISR group(P<0.05),in line with the overall trends.7 The TBIL after PCI in ISR group patients increased higher than that in non-ISR group,especially obvious at one month after operation.The serum bilirubin level measured at half a month,one month,three months,six months after PCI between two groups were statistical different(P: 0.0251,0.031,0.000,0.000,respectively).8 In DES group,comparing the TBIL,DBIL and IBIL by linear correlation analysis,it showed that:1)The correlation coefficient between DBIL and TBIL was 0.825,P=0.000<0.05.The DBIL rose gradually as TBIL did.2)The correlation coefficient between IBIL and TBIL was 0.672,P=0.001<0.05.The IBIL rose gradually as TBIL did.3)The correlation coefficient between DBIL and TBIL(r=0.825)was higher than that between IBIL and TBIL(r=0.672).The change of TBIL after PCI in CHD patients had more close correlation with DBIL,that is to say the change of TBIL was mainly caused by DBIL.Conclusions 1 The TBIL level after PCI is higher than that before operation and this phenomenon is more obvious in patients with ISR.2 The changes of serum bilirubin level after PCI operation may be related to intimal hyperplasia of impaired coronary artery.3The changes of serum bilirubin level after PCI operation is mainly caused by DBIL. |
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