Schwertner H A, Fischer J R
59 MDW/MSRL, Clinical Research Squadron, Wilford Hall Medical Center, 1255 Wilford Hall Loop, 78236-5319, Lackland AFB, TX, USA.
Atherosclerosis. 2000 Jun;150(2):381-7. doi: 10.1016/s0021-9150(99)00387-1.
Studies were performed to determine if serum bilirubin, when combined with various lipid and lipoprotein risk factors, enhances our ability to predict coronary artery disease (CAD). This hypothesis was tested in a retrospective study of 644 middle-aged males who had undergone coronary angiography. The traditional risk factors of cholesterol, high density lipoprotein cholesterol (HDL-C), cholesterol/HDL-C ratios, triglycerides, age, cigarette smoking, and systolic blood pressure were tested by discriminant analysis, as were various cholesterol/bilirubin, cholesterol/(HDL-C+bilirubin), and low-density lipoprotein cholesterol (LDL-C)/(HDL-C+bilirubin) ratios. Each of these bilirubin-containing ratios was found to be an independent risk predictor when tested with the traditional risk factors. When the LDL-C/(HDL-C+bilirubin) ratio was included with the traditional risk predictors, it improved the prediction of severe CAD from 28.4 to 35.3% and the overall correct classification of CAD from 68.3 to 71.1%. When the 75th percentile was used as a cut-point, the diagnostic sensitivities obtained with cholesterol/(HDL-C+bilirubin) ratios (52.1%) and LDL-C/(HDL-C+bilirubin) ratios (51.7%) were better than those obtained with cholesterol/HDL-C ratios (40.4%) (P=0.033 and 0.048, respectively). LDL-C/(HDL-C+bilirubin) ratios also improved the prediction of severe CAD over those obtained with LDL-C/HDL-C ratios (43.4%); however, the changes were not statistically significant (P=0.096). If confirmed in other populations, serum bilirubin may be combined with LDL-C/HDL-C ratios, cholesterol/HDL-C ratios, cholesterol, or with various apolipoproteins to improve the prediction of CAD.
开展了多项研究以确定血清胆红素与各种脂质和脂蛋白风险因素相结合时，是否能增强我们预测冠状动脉疾病（CAD）的能力。这一假设在一项对644名接受冠状动脉造影的中年男性进行的回顾性研究中得到了验证。通过判别分析对胆固醇、高密度脂蛋白胆固醇（HDL-C）、胆固醇/HDL-C比值、甘油三酯、年龄、吸烟和收缩压等传统风险因素进行了测试，同时也对各种胆固醇/胆红素、胆固醇/（HDL-C + 胆红素）和低密度脂蛋白胆固醇（LDL-C）/（HDL-C + 胆红素）比值进行了测试。当与传统风险因素一起测试时，发现这些含胆红素的比值中的每一个都是独立的风险预测指标。当将LDL-C/（HDL-C + 胆红素）比值纳入传统风险预测指标时，它将严重CAD的预测率从28.4%提高到了35.3%，并将CAD的总体正确分类率从68.3%提高到了71.1%。当以第75百分位数作为切点时，胆固醇/（HDL-C + 胆红素）比值（52.1%）和LDL-C/（HDL-C + 胆红素）比值（51.7%）获得的诊断敏感性优于胆固醇/HDL-C比值（40.4%）（P分别为0.033和0.048）。与LDL-C/HDL-C比值（43.4%）相比，LDL-C/（HDL-C + 胆红素）比值也改善了对严重CAD的预测；然而，变化没有统计学意义（P = 0.096）。如果在其他人群中得到证实，血清胆红素可与LDL-C/HDL-C比值、胆固醇/HDL-C比值、胆固醇或各种载脂蛋白相结合，以改善对CAD的预测。
