目的: 观察冠心病新的危险因素血清脂蛋白( a) ［LP( a) ］、同型半胱氨酸( Hcy) 、胱抑素C( Cys C) 、
总胆红素( TBIL) 、血尿酸( SUA) 及血浆纤维蛋白原( Fib) 水平与冠心病( CHD) 类型、血管病变的关系方法实验
组为CHD 病人共150 例，又分为3 个亚组即急性心肌梗死( AMI) 组50 例，不稳定性心绞痛( UAP) 组50 例及稳
定性心绞痛( SAP) 组50 例。对照组为健康人群30 例。外周血测定LP( a) 、Hcy、Cys C、TBIL、SUA、Fib．结果:
( 1) 将CHD 组与对照组比较时发现TBIL 水平低于对照组( P＜0．05) ; 余5 项指标均高于对照组并有统计学意
义。( 2) 对不同亚组将各项指标进行比较时，发现从SAP、UAP 到AMI 组TBIL 逐渐下降，余5 项指标水平逐渐
增高。Cysc 水平AMI 组高于SAP 组( P＜0．01) 。Hcy 水平3 个亚组比较均有统计学意义。Fib 水平AMI 组高于
SAP 组( P＜0．05) ; UAP 组高于SAP 组( P＜0．05) 。UA 水平AMI 组高于SAP 组( P＜0．01) ; UAP 组高于SAP 组( P
＜0．01) 。( 3) 当按冠状动脉不同血管病变组对各项指标进行比较，发现从单支、双支到三支病变组TBIL 逐渐下
降，余5 项指标逐渐增高。TBIL 水平三支组低于一支病变组( P＜0．01) ; 三支组低于于双支组( P＜0．05) 。Cysc
三支组高于一支组( P＜0．05) 。Hcy 水平3 个血管病变组比较均有统计学意义。Lp( a) 三支组高于一支组( P＜
0．05) 。结论: 这六项指标均与CHD 相关。TBIL 和LP( a) 与冠脉狭窄关系更密切，UA 和Fib 与斑块不稳定性关
系更密切，而Hcy 和Cys C 与这两方面都密切相关。

Objective: To observe the relationship among the type 、vessel lesions of coronary heart
disease( CHD) and the level of new risk factors that includes serum lipoprotein( a) ［LP( a) ］、homocysteinemia
［Hcy ］、cystatin C ( CysC) 、total bilirubin ( TBil ) 、serum uric acid ( SUA) and plasma
fibrinogen( Fib) ．Methods: Experimental group for a total of 150 patients with CHD， is divided into
three subgroups that 50 cases of acute myocardial infarction( AMI) group，50 cases of unstable angina
pectoris( UAP) group and 50 cases of stable angina pectoris( SAP) group．Control group is made up of
30 cases of healthy people．Experimental group and control group are taken blood determination of LP
( a) 、Hcy、Cys C、TBIL、SUA and Fib．Ｒesults: ( 1) When comparing the CHD group with the control
group， the TBIL level was lower than the control group( P＜0．05) ．The remaining five indexes were high-
er than the control group and had statistical significance．( 2) Compared the indexes with different subgroups，
from SAP、UAP to AMI group it was found that TBIL gradually decline， the other 5 indexes level
gradually increased．Levels of Cysc of AMI group is higher than the SAP group( P＜0．01) ．Compared
three subgroups levels of Hcy all had statistical significance．levels of Fib， the AMI group is higher than
the SAP group( P＜0．05) ; the UAP group was higher than the SAP group( P＜0．05) ．Levels of UA， the
AMI group is higher than the SAP group( P＜0．01) ; the UAP group was higher than the SAP group( P＜
0．01) ．( 3) When Compared the indexes among the different coronary artery vascular lesions groups， it
was found that TBIL gradually decline， the other five indexes gradually increased from single branch
group、double branch group to three branch group．The level of TBIL， three branch group was below
single branch group( P＜0．01) and lower than the two branch group( P＜0．05) ．The level of Cysc， three
branch group was higher than single branch group( P＜0．05) ．Compared three groups levels of Hcy all
had statistical significance．The level of Lp( a) ， three branch group was higher than single branch group
( P＜0．05) ．Conclusion: These six indexes are more closely related to CHD．TBIL and LP( a) are related
to coronary stenosis，and UA and Fib are more closely related to plaque instability，while Hcy and Cys
C are closely related to both．

Ｒ541．4

 收稿日期: 2017－12－17; 修回日期: 2018－02－14
基金项目: 内蒙古医科大学附属医院一般项目( NYFY YB2014023)
作者简介: 李爱英( 1971－) ，女，内蒙古医科大学附属医院心内科主任医师。