The Analysis Of The Relationship Between Serum Total Bilirubin And Fibrinogen In Patients With Coronary Heart Disease

Objective:To analyze the relationship of serum total bilirubin, Fibrinogen, the ratio of fibrinogen to total bilirubin (FIB/TBIL) and Gensini scores by measuring them in patients with coronary heart disease(CHD) and non- coronary heart disease (NCHD)who were diagnosed by coronary angiography, and to appraise the diagnostic evaluation of CHD by measuring Fib/TBIL.Methods: We studied 186 people, who underwent coronary angiography (CAG) in The Fourth Hospital of HeBei Medical University from January 2007 to January 2009, without infection,liverd and kindet disease,congestive heartfailure,disorder of blood clotting,peripheric blood vessel disease,tumour,operation . According to the results of CAG , all the cases were classified as CHD group(the severity of coronary artery≥50% at least one ramus , including 100 men and 31 women, average age 59.81±10.866 years) and non-CHD group(the severity of coronary artery <50%, including 23 men and 32 women, average age 54.84±10.626 years). TO analyze the constrictive degree of every coronary artery ramus by Gensini scores system, the ultimate scores was the summation of every score. The serum total bilirubin, fibrinogen, total cholesterol, triglyceride, high-density lipoproteins, low-density lipoprotein, very low density lipoprotein , lipoprotein (a) were determined by technician of laboratory in Fourth Hospital of HeBei medical University.The smoking, hypertension, diabetes were diagnosed by international criterions now. The data was dealed by the statistics software of SPSS13.0. The mormal distributional data was expressed by mean±standard deviation, the comparison of two groups was analyzed by two–sample test for independent samples, the association of data was analyzed by Linear correlation; the skewness distributional data was expressed by median, the comparison of two groups was analyzed by Wilcoxonrank sum test, the association of data was analyzed by Spearman correlation from ranks. The constituent ratio of smoking,hypertension and diabetes in two groups were analyzed by chi-square criterion . The diagnostic evaluation of Fib/TBIL to CHD was analyzed by ROC curve. The association of every index with Gensini scores and CHD were analyzed by Multiple linear stepwise regression analysis and Multiple logistic regression analysis. P<0.05 was considered statistically significant.Result:1 The numerus of TBIL in the CHD group and the NCHD group were 9.2908±2.38525μmol/L and 13.9764±4.31071μmol/L respectively; the numerus of Fib in the CHD group and the NCHD group were 3.8355±1.14501g/L and 2.7833±0.8646g/L respectively. The level of TBIL in CHD group was lower than it in NCHD group(P<0.01);and the level of Fib in CHD group was higher than it in NCHD group(P<0.01).2 In the CHD group, the numerus of TC, VLDL, TG, HDL, VLDL, LPa were 5.0858±1.24523 mmol/L, 3.1433±1.00838 mmol/L, 1.42mmol/L, 1.2 mmol/L, 0.4 mmol/L, 221 mg/L respectively; in the NCHD group, the TC, VLDL, TG, HDL, VLDL, LPa were 4.8764±1.21975 mmol/L , 2.9873±1.05364 mmol/L, 1.32mmol/L, 1.24mmol/L, 0.38mmol/L, 116mg/L respectively. The level of TC, TG, HDL, LDL, VLDL had no difference between two groups(P>0.05); the level of LPa in CHD group was higher than it in NCHD group(P<0.01). 3 The numerus of TBIL/Fib in the CHD group and the NCHD group were 0.384615 and 0.196644 respectively, whereas there was statistically significant(P<0.01). To analyze Fib/TBIL by ROC, the area under the ROC curve was 0.88(P<0.01)and the sensitivity and specificity of diagnosing CHD were 90.1%and 80.0 % when Fib/TBIL was 0.257027.4 Linear correlation reveal that Gensini scores were positively correlation with both Fib and Fib/TBIL(r=0.25, P < 0.01; r=0.362, P < 0.01) and negatively correlated with TBIL(r=-0.293,P<0.01).Putting Fib and TBIL into Multiple linear stepwise regression analysis again showed Fib,TBIL,LPa,age entered regression equation.The regression equation is: Gensini scores =-4.743+2.842Fib-1.83TBIL +0.045LPa +0.377 age (R=0.655, R²=0.429, R_adj²=0.411);and Putting Fib/TBIL into Multiple linear stepwise regression analysis showed Fib/TBIL,LPa,age entered regression equation.The regression equation is: Gensini scores= -22.902+ 28.239Fib/TBIL + 0.045 LPa+0.363age(R=0.674,R²=0.454, R_adj²=0.441).5 Putting Fib,TBIL,Fib/TBIL,TC,TG,HDL,LDL,VLDL,LPa,age,sex,smoking,hypertension ,diabetes into Multiple logistic regression analysis showed age,sex,Fib,TBIL,Fib/TBIL,LPa entered regression equation, partial regression coefficient were -2.077,0.733,1.888,-2.043,1.677,1.544 respectively, constant were -2.712. Considering age,sex,Fib,TBIL,Fib/TBIL,LPa were independent Risk factor in my investigation, the OR were 0.125,2.081,6.608,0.13,5.349,4.683 respectively.Conclusion: Fib,TBIL,Fib/TBIL are independent Risk factor of coronary artery disease. The severity of coronary artery is positively correlation with both Fib and Fib/TBIL, and negatively correlated with TBIL. To CHD, Fib/TBIL has certain diagnostic evaluation.Both lower bilirubin and higher fibrinogen promote coronary heart disease.