ACS患者血浆纤维蛋白原与冠状动脉病变严重程度的关系  

The Relationship between plasma fibrinogen level and severity of coronary artery disease in patients with acute coronary syndrome

作　　者：郑淑苹 罗超迪 王萍 栾慧 曹丽菲 罗醒 王小可 张晓玉 朱丹军[1] 田刚[1] ZHENG Shuping;LUO Chaodi;WANG Ping;LUAN Hui;CAO Lifei;LUO Xing;WANG Xiaoke;ZHANG Xiaoyu;ZHU Danjun;TIAN Gang(Department of Cardiology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,710061,China)

机构地区：[1]西安交通大学第一附属医院心血管内科,西安710061

出　　处：《临床心血管病杂志》2021年第7期625-631,共7页Journal of Clinical Cardiology

基　　金：国家自然科学基金项目(No:81873513,81600574,30871042);陕西省科学技术研究发展计划重点项目(No:2018ZDXM-SF-049);西安交通大学第一附属医院临床研究重点项目(No:XJ-TU1AF-CRF-2018-005)。

摘　　要：目的:探讨急性冠状动脉综合征(ACS)患者血浆纤维蛋白原(fibrinogen,FIB)水平与冠状动脉(冠脉)病变严重程度的关系。方法:选择2018-11-01—2019-11-01就诊于西安交通大学第一附属医院心血管内科诊断为ACS的患者1106例(病例组),以及294例冠脉造影正常的患者(对照组)。应用Gensini评分和冠脉病变支数等评估冠脉病变的严重程度,采用Von Clauss法检测血浆FIB。按照ACS患者FIB水平的三分位数,分为T1组(FIB≤2.83 g/L)、T2组(2.83 g/L)、T2组>T1组(均P<0.05),T3组冠脉病变支数明显多于T2组、T1组[分别为(2.27±0.82)支、(2.05±0.84)支和(1.94±0.86)支,均P<0.05],T3组、T2组冠脉狭窄≥75%患者比例明显高于T1组[分别为82.6%、78.7%和69.8%,均P<0.05];(3)FIB水平3支病变组>双支病变组>单支病变组(均P<0.05),重度狭窄组FIB水平>中度狭窄组>轻度狭窄组(均P<0.05),STEMI组和NSTEMI组FIB水平高于UA组[分别为(3.47±1.56)g/L、(3.51±0.96)g/L和(3.15±0.71)g/L,P<0.01];(4)Spearman相关性分析显示,ACS患者血浆FIB水平与Gensini评分(rs=0.201,P<0.001)、冠脉病变支数(rs=0.171,P<0.001)存在正相关;多因素Logistic回归分析在调整了混杂因素后显示,FIB是ACS患者高Gensini评分的危险因素之一(OR=1.38,95%CI 1.20~1.60,P<0.001)。结论:ACS患者血浆FIB水平与Gensini评分、冠脉病变支数呈正相关,是评估冠脉病变严重程度的危险因素之一。Objective:To explore the relationship between the plasma fibrinogen(FIB)level and the severity of coronary artery disease in acute coronary syndrome(ACS)patients.Methods:The 1106 patients with ACS(case group)and 294 patients with normal coronary angiography(control group)were selected in the study.The severity of coronary artery was evaluated by Gensini score and the number of coronary artery stenosis.The plasma FIB was detected by Von Clauss method.According to the FIB level,they were divided into T1 group(FIB≤2.83 g/L),T2 group(2.83 g/L),T2 group>T1 group(all P<0.05),the number of coronary artery lesions in T3 group was significantly more than that in T2 and T1 groups(2.27±0.82)vs.(2.05±0.84),(2.27±0.82)vs.(1.94±0.86)respectively,both P<0.05,the proportion of patients with coronary stenosis≥75%in the T3 and T2 groups was significantly higher than that in the T1 group[82.6%vs.69.8%,78.7%vs.69.8%respectively,both P<0.05];(3)The FIB level of the three-vessel lesion group>the double-vessel lesion group>the single-vessel lesion group(all P<0.05).The FIB level of the severe stenosis group>the moderate stenosis group>the mild stenosis group(all P<0.05).The FIB levels of the STEMI group and the NSTEMI group were significantly higher than that of the UA group[(3.47±1.56)g/L vs.(3.15±0.71)g/L,(3.51±0.96)g/L vs.(3.15±0.71)g/L,respectively,both P<0.01).(4)Spearman’s correlation analysis showed that plasma FIB level in ACS patients was correlated with Gensini score(rs=0.201,P<0.001)and the number of coronary artery lesions(rs=0.171,P<0.001)positively.Multivariate Logistic regression analysis,after adjusting for confounders,showed that FIB was one of the risk factors for the high Gensini score of coronary lesions in patients with ACS(OR=1.38,95%CI1.20-1.60,P<0.001).Conclusion:The level of plasma FIB in ACS patients was positively correlated with Gensini score and the number of coronary lesions.Plasma FIB was one of the risk factors for evaluating the severity of coronary lesions.

关 键 词：急性冠状动脉综合征 纤维蛋白原 GENSINI评分 

分 类 号：R541.4[医药卫生—心血管疾病]