中文摘要：

目的研究血清可替宁水平与冠心病的关系,探讨其在冠心病中的临床应用价值。方法按冠状动脉造影结果将149例研究对象分为冠心病组（97例）和非冠心病对照组（52例）,进行病例对照研究,同位素稀释串联质谱法（isotope dilution tandem mass spectrometry,ID-LC/MS/MS）测定血清可替宁浓度,分析可替宁与冠心病及其他危险因素的关系。结果 149例行冠状动脉造影患者血清可替宁浓度呈偏态和尖态分布（偏度2.90,峰度7.96）,吸烟者的可替宁浓度为12.64（0.91～99.61）μg/L,显著高于非吸烟者[0.22（0.12～0.51）μg/L,P〈0.001]。高可替宁水平组（〉10.00μg/L）患冠心病的风险显著高于低可替宁水平组（〈1.00μg/L）（OR=2.94,95%CI：1.11～7.78,P〈0.05）;且随着血清可替宁水平的升高,OR值增大呈量效关系（均为P〈0.05）。多因素Logistic回归分析显示,糖尿病、血脂异常及可替宁为最显著的危险因素（均为P〈0.05）。血清可替宁与吸烟（r=0.656,P〈0.001）和白细胞计数（WBC,r=0.257,P=0.010）呈显著正相关,与HDL-C（r=-0.184,P=0.025）和HDL2-C（r=-0.217,P=0.008）呈显著负相关。结论血清可替宁水平能够有效地反映吸烟的暴露水平,其水平升高能够增加患冠心病的危险。

英文摘要：

Objective To assess the association between serum cotinine and coronary artery disease（CAD）. Methods A total of 149 hospitalized patients underwent coronary angiography were included.Patients were divided into CAD group（n=97） and non CAD control group（n=52） according to coronary angiogram.Serum cotinine concentrations were determined by isotope dilution tandem mass spectrometry（ID-LC/MS/MS）. Results Serum cotinine levels of 149 subjects were shown skewed and leptokurtic distribution.Cotinine levels of smokers were significantly higher than non-smokers [12.64（0.91-99.61） μg/L vs.0.22（0.12-0.51） μg/L,P0.001].CAD risk in the highest cotinine level group（10 μg/L） was significantly higher than in the lowest group（1 μg/L）,the OR value was 2.94（95% CI： 1.11-7.78,P0.05）.With the increment of serum cotinine level,OR increased in parallel with dose-effect relationship（all P0.05）.Multifactor logistic regression analysis showed that diabetes,dyslipidemia and cotinine were the most marked risk factors（all P0.05）.Cotinine level was positively correlated with smoking（r=0.656,P0.001） and white blood cell counts（WBC,r=0.257,P=0.010）,and negatively correlated with HDL-C（r=-0.184,P=0.025） and HDL2-C（r=-0.217,P=0.008）. Conclusions Serum cotinine can effectively reflect smoking exposure,and the increased serum level of cotinine is associated with the development of CAD.