王觀華， 胡增敏， 向海霞， 方　鵬

(柞水縣人民醫(yī)院 內(nèi)一科， 陜西 柞水　711400)

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血清總膽汁酸水平與老年人冠心病的相關(guān)性

王觀華， 胡增敏， 向海霞， 方鵬

(柞水縣人民醫(yī)院 內(nèi)一科， 陜西 柞水711400)

目的： 檢測血清總膽汁酸(TBA)水平與老年人冠心病(CHD)的相關(guān)性。方法： 40例(穩(wěn)定性心絞痛)老年CHD患者作為觀察組(用Gensini評分評價CHD的嚴(yán)重程度)，42例同期老年健康體檢者作為對照組，取觀察組入院時或?qū)φ战M體檢當(dāng)日的血清，采用全自動生化儀檢測總膽固醇(TC)、高密度脂蛋白(HDL-c)、低密度脂蛋白(LDL-c)及甘油三脂(TG)等血脂指標(biāo)，白介素-6(IL-6)、腫瘤壞死因子-α(TNF-α)等炎癥因子及TBA的表達(dá)，比較2組受檢者血清血脂指標(biāo)、炎癥因子和TBA水平；采用Spearman法分析冠心病患者TBA與血脂指標(biāo)、炎癥因子及Gensini評分的相關(guān)性。結(jié)果： 與對照組比較，觀察組除TC、TNF-α及TBA水平顯著升高，差異有統(tǒng)計學(xué)意義(P<0.05)；Spearman法分析結(jié)果顯示，老年CHD患者血清TBA水平與TC、TNF-α及Gensini評分均呈現(xiàn)顯著正相關(guān)(r=0.787、0.924、0.837，P<0.01)。 結(jié)論： 老年CHD患者TBA水平顯著升高，且與疾病嚴(yán)重程度密切相關(guān)。

冠狀動脈硬化； 心臟??； 老年人； 總膽汁酸； 炎癥趨化因子類； 血脂

[Abstract]Objective: To analyze the correlation between serum total bile acid level(TBA) and coronary heart disease of aged patients. Methods: 40 cases of patients with (stable angina) CHD were collected as observation group (with the Gensini score evaluating the severity of coronary heart disease) and 42 cases of healthy old people in the same period as control group. Serum was collected from observation group at admission and control group at examination day. The automatic biochemical analyzer was adopted to detect blood lipid indexes including serum total cholesterol(TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglyceride (TG), and inflammatory factors including interleukin-6 (IL-6), tumor necrosis factor alpha (TNF alpha) and other inflammatory cytokines and TBA, all of which were compared between observation group and control group.Spearmanmethod was used to analyze the correlation between TBA and serum lipid, inflammatory factors and Gensini score in patients with CHD. Results: The patients in observation group had higher levels of TBA, TC and TNF-α than those of control group, and the difference were statistically significant (P<0.05). The result ofSpearmananalysis showed that in observation group, the levels of TBA was significantly positive correlated with TC and TNF-α and Gensini score(r=0.787、0.924、0.837，P<0.01). Conclusion: TBA level was significantly elevated in elderly patients with coronary heart disease, and is closely related to the severity of the disease.

[Key words]coronary artery sclerosis; heart disease；the aged; total bile acid; chemokines; blood lipid

冠狀動脈粥樣硬化性心臟病(coronary heart disease，CHD)是我國最為常見的心血管系統(tǒng)疾病之一，目前認(rèn)為血脂代謝紊亂與血管內(nèi)皮細(xì)胞受損的交互作用在該病的發(fā)生和發(fā)展中起著重要作用[1-4]。高脂血癥是公認(rèn)的CHD危險因素，新近的研究顯示血清總膽汁酸(total bile acid，TBA)水平升高與CHD的發(fā)生發(fā)展有關(guān)[5]。本研究以老年CHD患者作為研究對象，觀察其外周血清TBA水平的改變。

1　對象與方法

1.1對象

2013年1月～2015年1月收治的40例CHD(穩(wěn)定性心絞痛)患者作為觀察組，年齡≥60歲，CHD的診斷符合《冠狀動脈粥樣硬化性心臟病診斷標(biāo)準(zhǔn)》[6]，參考文獻(xiàn)[7]采用Gensini評分評估CHD的病變嚴(yán)重程度；排除有合并心臟手術(shù)史、其它心臟器質(zhì)性病變、活動性感染及惡性腫瘤等終末期疾病患者。另選取42例同期老年健康體檢者作為對照組。2組研究對象的性別、年齡等基礎(chǔ)資料比較，差異無統(tǒng)計學(xué)意義(P>0.05)，具有可比性，見表1。

表1　兩組被檢者一般資料比較

1.2方法

分別抽取觀察組入院時或?qū)φ战M體檢當(dāng)日的空腹外周靜脈血5 mL，分離血清。采用全自動生化儀檢測：(1)總膽固醇(total cholesterol，TC)、高密度脂蛋白(high-density lipoprotein，HDL-c)、低密度脂蛋白(low-density lipoprotein，LDL-c)及甘油三脂(triglyceride，TG)等血脂指標(biāo)；(2)白介素-6(interleukin-6，IL-6)、腫瘤壞死因子-α(tumor necrosis factor-α，TNF-α)等炎癥因子；(3)TBA。

1.3統(tǒng)計學(xué)方法

2　結(jié)果

2.1血脂指標(biāo)、炎癥因子及TBA

與對照組比較，觀察組除TC、TNF-α及TBA水平顯著高，差異有統(tǒng)計學(xué)意義(P<0.05)外，其余指標(biāo)比較，差異無統(tǒng)計學(xué)意義(P>0.05)。見表2。

表2　兩組被檢者血脂指標(biāo)、炎性因子及TBA比較

2.2老年CHD患者TBA與TC及TNF-α的相關(guān)性

如圖1所示，老年CHD患者血清TBA水平與TC及TNF-α均呈現(xiàn)顯著正相關(guān)(r=0.787、0.924，P<0.01)。2.3老年CHD患者TBA與Gensini評分的相關(guān)性

如圖2所示，老年CHD患者TBA水平與Gensini評分呈現(xiàn)顯著正相關(guān)(r=0.837，P<0.01)。

3　討論

我國心血管疾病的發(fā)病率逐年攀升，這可能與我國人口老齡化、西方化的生活飲食方式及食品安全惡化等因素有關(guān)[8]。目前認(rèn)為脂質(zhì)代謝紊亂是CHD發(fā)病的主要推動力量[9-10]。并發(fā)高血脂在CHD人群中十分常見，內(nèi)、外源性膽固醇的代謝異常導(dǎo)致的血清總膽固醇及低密度脂蛋白水平升高在冠狀動脈粥樣硬化的形成過程中起到了重要作用[11]。膽固醇的代謝主要在肝臟，肝臟可以將膽固醇轉(zhuǎn)化為膽汁酸進(jìn)入腸道。正常人體具有將過多攝入的膽固醇轉(zhuǎn)化為膽汁酸排出體外的內(nèi)力，而如果無法排出過多的膽汁酸將會導(dǎo)致血清TBA水平升高[12]。TBA具有細(xì)胞毒性作用，可以損傷血管內(nèi)皮細(xì)胞，這種細(xì)胞毒性作用且具有劑量依賴性[5, 13]。鑒于此，本研究從分析老年CHD患者血清TBA著手，探討TBA與血脂及血清炎癥因子間的相關(guān)性，分析TBA與CHD的關(guān)系，以期為CHD的臨床診療提供一定數(shù)據(jù)支持和參考。

圖1　老年CHD患者血清TBA與TC及TNF-α的相關(guān)性Fig.1　Correlation of serum TBA with TC and TNF-α in patients with coronary heart disease

本研究結(jié)果顯示，老年CHD患者血清TC、TNF-α及TBA水平顯著高于老年健康體檢者。提示TBA可能與CHD有一定關(guān)聯(lián)，同時再次證實(shí)血清TC、TNF-α水平與CHD發(fā)病有關(guān)。TNF-α是經(jīng)典的促炎因子，在慢性炎癥的維持及急性炎癥的級聯(lián)放大中均發(fā)揮關(guān)鍵作用[14-15]。血管內(nèi)皮受損及全身性慢性炎癥是CHD的主要發(fā)病機(jī)制假說之一。本研究的相關(guān)性分析結(jié)果顯示，CHD患者血清TBA與TNF-α及TC均呈現(xiàn)顯著正相關(guān)。這提示TBA可能同時與血脂代謝及系統(tǒng)性炎癥反應(yīng)相關(guān)，推測TBA可能與CHD的嚴(yán)重程度亦相關(guān)，Gensini評分可直接反映冠心病的嚴(yán)重程度，本研究結(jié)果顯示老年CHD患者TBA與Gensini評分呈現(xiàn)顯著正相關(guān)關(guān)系，佐證上述推斷。提示檢測老年CHD患者血清TBA可推斷疾病進(jìn)展情況。

綜上，老年CHD患者TBA水平顯著升高，且與疾病嚴(yán)重程度密切相關(guān)，提示其在該病的發(fā)生或發(fā)展中發(fā)揮一定作用。

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(2016-02-01收稿，2016-07-01修回)

中文編輯： 吳昌學(xué)； 英文編輯： 劉華

Correlation between Serum Total Bile Acid Level and Coronary Heart Disease in the Elderly

WANG Guanhua, HU Zengmin, XIANG Haixia, FANG Peng

(ThePeople'sHospitalofZhashuiCounty,Zhashui711400,Shanxi,China)

R541.4

A

1000-2707(2016)08-0980-04

10.19367/j.cnki.1000-2707.2016.08.029

網(wǎng)絡(luò)出版時間：2016-08-23網(wǎng)絡(luò)出版地址：http://www.cnki.net/kcms/detail/52.5012.R.20160823.1343.034.html