Study Of Relationship Of Serum Total Bilirubin,Lipoprotein(a) And Urinary Microalbumin In Patients With Acute Coronary Syndrome

Objective:To investigate the relationship of serum Serum bilirubin(BIL),Lipoprotein ( a ) [Lp(a)],urinary Microalbuminuria(MA)with acute coronary syndrome(ACS) and severity of coronary artery stenosis by testing serum total bilirubin(TBIL),direct bilirubin(DBIL), indirect bilirubin(IBIL), Lp(a), total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and coronary artery stenosis Gensini scores in patients with ACS and NCHD.Methods:119 patients who were hospitalized in the second hospital of hebei medical university and underwent coronary angiography(CAG) from december 2007 to november were choosed to be study. According to the results of CAG and clinical diagnosis, All the patients were classified as ACS group,84 cases,including unstable angina (UA) group of 48 cases and acute myocardial infarction group (AMI) of 36 cases,and control (CONTROL) group, 35 cases. There was no significant difference among the three groups in age and sex ratio. Coronary angiography was carried by fixed doctors by Judkins method through arteria radialis or arteria cruralis, as a contrast agent Ultravist(370),multi-position projection,we used Gensini scores for quantitative analysis of all coronary stenosis degree: stenosis <25% recorded for 1 score, 25% -50% recorded for 2 scores,> 50% -75% recorded for 4 scores,> 75% -90 recorded for 8 scores,> 90% -99% recorded for 16 scores, 100% recorded for 32scores.The integration of the scores was used for evaluation the severity of coronary artery stenosis. All patients took blood from ulnar vein in the early morning the next day after fasting for 12 hours for testing serum bilirubin, blood sugar and blood lipid. Acquisition urine of 24h from morning 7:00 to 7:00 the following morning, taking a urine cup after shaken,then we tested urinary albumin excretion rate with the method of immune nephelometry. All the cases were measured body height and weight,then BMI was calculated.We judged smoking,hypertension,diabetes In accordance with international standards. All the statistic analyses were performed with SPSS software pack(Version 11.5).All measurement data were presented as mean±standard deviation.Age, lipids, body mass index, serum bilirubin, lipoprotein (a),urinary albumin excretion rate of the three groups were compared with single-factor analysis of variance.Smoking Tobacco,hypertension,diabetes mellitus constitutes of three groups were compared with X2 test,The relationship between Gensini scores and blood lipids, blood glucose, serum bilirubin, lipoprotein (a), urinary albumin excretion rate was analyzed by linear correlation and multiple liner stepwise regression. p<0.05 was considered statistically significant. Results:1.Gender ratio of three groups was 28/8,37/11 and 25/10, respectively. Proportion of combining with diabetes was 27.8%,18.8%,22.9%, respectively. Proportion of combining with hypertension was 63.9%,60.4%,57.1%.There was no statistically significant by X2 test,p>0.05.The history of smoking in AMI group and UA group was higher than control group,the difference was statistically significant,p<0.05.There was no significant difference between AMI group and UA group.Age, cholesterol, triglycerides,low-density lipid Protein,high-density lipoprotein,blood glucose,body mass index of three groups were normal distribution,and analyzed by analysis of variance,There was no significant difference,p>0.05.②Urinary albumin excretion rate in the AMI group and the UA group were (15.95±2.26)μg/min and (15.55±1.54)μg/min,and were higher than that of contol group (10.19±0.38)μg/min,there was statistical significance,p<0.05. AMI group was higher than the UA group, the difference was not statistically significant p>0.05. Lipoprotein(a) in the AMI group and the UA group were (175.56±10.65)mg/L and (177.5±6.81)mg/L,were higher than that in control group,( 148.57±6.31)mg/L,the difference was statistically significantly,p<0.05,there was no significant difference between AMI group and the UA group.Total bilirubin and direct bilirubin in the AMI group and the UA group were lower than those in control group,the difference was statistically significant,p<0.05,there was no significant difference between AMI group and the UA group.There was no significant difference in Indirect bilirubin in three groups,p> 0.05.③Linear correlation revealed that both Urinary albumin excretion rate and lipoprotein (a) had positively correlation with coronary score,p<0.05,r=0.256,0.220;Total bilirubin and direct bilirubin were negative correlation with Gensini scores,p<0.05, r=-0.282,-0.267.④Multiple linear stepwise regression analysis showed TBIL and UAER enter regression equation.The regression equation is: Gensini score=43.946-0.952TBIL+0.336 UAER.Conclusion:1.Urinary albumin excretion rate in acute coronary syndrome patients increased and was positively correlated with severity of coronary artery disease. Microalbuminuria can be used as an index of evaluation of the degree of coronary heart disease.As its detection was simple,convenient,economic,and non-invasive,we could use it as a routine clinical examination to help us find and evaluate severity of coronary artery disease of ACS patients,then we can have early intervention to improve the prognosis.2.Bilirubin is a very strong and effective physiological antioxidants, which can inhibit lipid oxidation and the formation of oxygen free radicals, the removal of oxygen free radicals and suppress immune response and inflammation, which plays a role of anti-atherosclerosis,delaying the progress of coronary heart disease and protecting our body.Level of serum total bilirubin and direct bilirubin was lower in acute coronary syndrome patients,and was negatively correlated with severity of coronary artery disease.Low concentrations of serum bilirubin was an independent risk factor of coronary atherosclerosis.3.The level of Lipoprotein (a) in the peripheral blood of acute coronary syndrome patients was much higher.The level of Bilirubin,lipoprotein(a) and urinary albumin excretion rate of those readily available clinical and biochemical indicators were likely be effective reference indicators for a forecast of the risk of coronary heart disease and an evaluation of the severity of coronary heart disease.