纤维蛋白原水平对急性心肌梗死患者远期预后的影响  

Impact of Plasma Fibrinogen Level on Long-term Prognosis in Patients With Acute Myocardial Infarction

作　　者：苏文[1] 李虹伟[1] 李卫萍[1] 陈晖[1] SU Wen;LI Hongwei;LI Weiping;CHEN Hui(Department of Cardiology,Beijing Friendship Hospital,Capital Medical University,Beijing(100050),China)

机构地区：[1]首都医科大学附属北京友谊医院心血管中心,北京市100050

出　　处：《中国循环杂志》2021年第9期858-862,共5页Chinese Circulation Journal

基　　金：国家自然科学基金青年项目(81900304);北京市教育委员会科技计划一般项目(KM201910025017);北京市优秀人才培养资助青年骨干个人项目(2018000021469G199);北京市医院管理中心“青苗计划”人才项目(QML20190103)。

摘　　要：目的:探讨纤维蛋白原水平对急性心肌梗死(AMI)患者远期预后的影响。方法:选取2013年1月1日至2020年1月31日首都医科大学附属北京友谊医院收治的AMI患者3990例,将纤维蛋白原水平按纳入的AMI患者人数等分为3组:纤维蛋白原≤2.62 g/L组(n=1337)、纤维蛋白原2.63~3.44 g/L组(n=1335)、纤维蛋白原≥3.45 g/L组(n=1318)。随访记录患者的重要心血管事件、是否死亡及死亡原因(心原性或非心原性死亡),研究终点预先设定为发生心原性死亡。应用Cox比例风险回归模型评估纤维蛋白原对心原性死亡的影响。结果:与纤维蛋白原≤2.62 g/L组和纤维蛋白原2.63~3.44 g/L组比较,纤维蛋白原≥3.45 g/L组患者年龄较大、女性居多,既往高血压、糖尿病比例较高,三支病变较为多见,住院期间N末端B型利钠肽原峰值明显升高,左心室射血分数<50%患者比例明显升高(P均<0.05)。中位随访时间为2.1(1.0,4.0)年。纤维蛋白原≥3.45 g/L组患者随访期间累计心原性死亡率(12.9%)高于纤维蛋白原≤2.62 g/L组(6.1%)和纤维蛋白原2.63~3.44 g/L组(7.1%),P均<0.05。校正其他危险因素后,纤维蛋白原仍能独立预测AMI患者的心原性死亡(HR=1.23,95%CI:1.04~1.46,P=0.017)。结论:纤维蛋白原水平能反映AMI患者病情的严重程度,纤维蛋白原是AMI患者远期发生心原性死亡事件的独立预测因子。Objectives:To investigate the relationship between plasma fibrinogen level and the risk of cardiac death in patients with acute myocardial infarction(AMI).Methods:From January 1,2013 to January 31,2020,3990 patients admitted in Beijing Friendship Hospital with AMI were included in this study.Patients were divided into 3 groups according to the level of plasma fibrinogen within 24 hours after admission:≤2.62 g/L,2.63-3.44 g/L,≥3.45 g/L,and patients were followed up for a median of 2.1 years(interquartile range 1.0-4.0).Cox proportional hazard regression was used to evaluate the impact of fibrinogen on cardiac death.Results:The patients in fibrinogen≥3.45 g/L group were older,more likely to be female,had higher prevalence of hypertension,diabetes,and multivessel disease,higher levels of N-terminal pro-brain natriuretic peptide,and more likely to have left ventricular ejection fraction<50%.The cardiac mortality rate was the highest in fibrinogen≥3.45 g/L group.After adjusting for other risk factors,fibrinogen remained as an independent risk factor of cardiac death in patients of AMI(HR=1.23,95%CI:1.04-1.46,P=0.017).Conclusions:Higher plasma level of fibrinogen within 24 hours post admission could reflect the severity of disease in AMI patients.In addition,plasma fibrinogen level is an independent risk factor of cardiac death in AMI patients.

关 键 词：纤维蛋白原 急性心肌梗死 心原性死亡 远期预后 

分 类 号：R54[医药卫生—心血管疾病]