The Association Between Serum Total Bilirubin Level And Prognosis Of Acute Myocardial Infarction With Chronic Renal Dysfunction

Background:With the development of modern economy,people's living standards gradually improve,comfortable lifestyle,high fat diet structure changes and social problems,the old population is becoming more and more serious,coronary heart disease(coronary heart disease CHD)is a chronic disease of serious harm to human health,the incidence has increased to an astonishing speed.With the development of society and economy,the medical level is also in constant progress,the whole world for the study of coronary heart disease and clinical aspects have been many,summed up several major theories,including oxidative stress,inflammatory reaction theory,will play a very important role.In so many theories,the theory of oxidative stress is an advocate of the theory,pointed out: the role of oxidative stress in the body,its lead to the formation of coronary artery plaque through the mechanism of a variety of complicated and complex,leading to atherosclerosis(arterosclerosis AS),the occurrence of vascular stenosis caused by ischemia.The CHD is divided into 5 types,including acute myocardial infarction(acute myocardial infarction AMI)is one of the most serious type of myocardial infarction,have clinical features for the prevalence of mortality is very high,the prognosis is very poor,is the main cause of death.Most researchers believe that:(arterosclerosis AS)in atherosclerotic plaque formation process,low density lipoprotein(Cligh-densitylipoprotein cholesterol LDL)oxidative modifications play a key role.In recent years,some scholars believe that bilirubin(bilirubin BIL)also has antioxidant effect,and also has an important protective effect on blood vessels,as well as plays an indispensable role in preventing plaque formation and development.In clinical practice,we frequently experience a combination of renal dysfunction in patients with acute myocardial infarction,especially when renal failure enters the end-stage stage.Because BIL is a natural product of endogenous antioxidant,in physiological oxygen concentration,its antioxidant capacity is far greater than the vitamin E and vitamin C,and blocking the formation of ox-LDL LDL with bilirubin oxidation function,inhibit the occurrence of atherosclerosis,so as to reduce the incidence of coronary heart disease.A variety of studies have demonstrated that BIL is associated with a range of oxidative stress related diseases that inhibit the formation of multiple ROS and reactive nitrogen species,thereby preventing plaque formation.Under physiological conditions,BIL plays an important role in the prevention and control of AS induced by ox-LDL.It is one of the antioxidants that can effectively inhibit the oxidation modification of ldl.Shcherbinina points out that BIL may be an independent factor,and may be a new predictor of coronary artery disease with other factors,and may even predict the occurrence of some other diseases.High level of BIL can reduce coronary blood flow reserve function damage,improve coronary microcirculation dysfunction,so as to reduce the incidence of coronary heart disease patients.The purpose of this study is to discuss the patients with renal insufficiency in patients with acute myocardial infarction(Chronic Renal failure CRF)patients,relationship between the levels of serum bilirubin in patients with long-term prognosis,provide a new reference for further long-term prognosis of such patients.Objective: The aim of this study is to determine the association between serum total bilirubin level and prognosis of acute myocardial infarction with chronic renal dysfunction.Method: 398 acute myocardial infarction patients with chronic renal dysfunction were enrolled in this study.These patients were separated into two groups: high bilirubin group(n=198)and low bilirubin group(n=200).Basic clinical characters were analyzed and major adverse cardiovascular events(MACEs)were observed during 12-48 months follow-up.Results: The results showed that during 12-48 months follow-up,death of any cause occurred in 1.5% patients(3 of 200)in low bilirubin group,as compared with 2.0% in the high bilirubin group(4 of 198)(hazard ratio,1.348;95% confidence interval,0.302 to 6.021;P=0.696).Kaplan-Meier survival analysis showed that there were no significant differences between the two groups with respect to the risk of death(P=0.695),revascularization(P=0.894),stroke(P=0.204),heart failure(P=0.267).Conclusion:High serum total bilirubin level increased the incidence of death,revascularization,stroke and heart failure in acute myocardial infarction patients with chronic renal dysfunction,but no statistical differences were found.