血浆D-二聚体/纤维蛋白原比值及超敏C反应蛋白在急性冠脉综合征中的临床价值
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摘要
目的分析急性冠脉综合征(ACS)患者血浆D-二聚体/纤维蛋白原比值(D/F比值)和超敏C反应蛋白(hs-CRP)水平与ACS患者冠脉狭窄程度及病情严重程度的相关性,探讨D/F比值的临床价值。方法收集2014年1月-2017年12月在南方医科大学南方医院心血管内科行冠状动脉造影检查的443例患者的病例资料,将其分为正常组、稳定型心绞痛(SAP)组和ACS组,进一步将ACS组按冠脉病变支数分为单支病变组、双支病变组和三支病变组,按Gensini积分中位数分为高Gensini积分组和低Gensini积分组。分析各组D-二聚体、纤维蛋白原、D/F比值及hs-CRP等4项指标与ACS的相关性,以及对ACS诊断预测及病变严重程度评估的价值。结果 D-二聚体、纤维蛋白原及hs-CRP在各组中总体趋势为正常组0.05);多因素logisitic回归分析结果显示,D/F比值和hs-CRP是ACS患者高Gensini积分的独立危险因素(OR=1.136,P=0.045;OR=1.197,P<0.001)。结论 D/F比值、hs-CRP与ACS患者冠脉病变的严重程度相关,是ACS患者高Gensini积分的独立危险因素。
Objective To analyze the correlation between D-dimer/fibrinogen(D/F) ratio, hypersensitive C-reactive protein(hs-CRP) level and the severity of coronary stenosis and illness in patients with acute coronary syndrome(ACS), and explore the clinical application value of D/F ratio. Methods The case data of 443 patients undergone coronary angiography in the Department of Cardiology, Nanfang Hospital, Southern Medical University during Jan. 2014 to Dec. 2017 were collected, and then the patients were divided into normal group, stable angina pectoris(SAP) group and acute coronary syndrome(ACS) group. The ACS group was divided into single-vessel disease group, double-vessel disease group and triple-vessel disease group according to the number of coronary lesions and into high Gensini score group and low Gensini score group according to the median of Gensini score. The correlations of D-dimer, fibrinogen, D/F ratio and hs-CRP with ACS were compared respectively, and then analyzing the predictive value for diagnosis of ACS and evaluation of lesion severity. Results The overall trend of D-dimer, fibrinogen and hsCRP was normal group0.05). Multivariate logistic regression analysis revealed that D/F ratio and hs-CRP were independent risk factors for high Gensini score in ACS patients(OR=1.136, P=0.045; OR=1.197, P<0.001). Conclusion D/F ratio and hs-CRP were significantly associated to the severity of coronary lesion, and were the independent risk factors for high Gensini score in patients with ACS.
Objective To analyze the correlation between D-dimer/fibrinogen(D/F) ratio, hypersensitive C-reactive protein(hs-CRP) level and the severity of coronary stenosis and illness in patients with acute coronary syndrome(ACS), and explore the clinical application value of D/F ratio. Methods The case data of 443 patients undergone coronary angiography in the Department of Cardiology, Nanfang Hospital, Southern Medical University during Jan. 2014 to Dec. 2017 were collected, and then the patients were divided into normal group, stable angina pectoris(SAP) group and acute coronary syndrome(ACS) group. The ACS group was divided into single-vessel disease group, double-vessel disease group and triple-vessel disease group according to the number of coronary lesions and into high Gensini score group and low Gensini score group according to the median of Gensini score. The correlations of D-dimer, fibrinogen, D/F ratio and hs-CRP with ACS were compared respectively, and then analyzing the predictive value for diagnosis of ACS and evaluation of lesion severity. Results The overall trend of D-dimer, fibrinogen and hsCRP was normal group
引文
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[21]Zhang XP,Hu Y,Yang Y,et al.Relationship between cerebral infarction and D-dimer/Fibrinogen ratio[J].J Clin Hematol,2006,19(4):216-217.[张小平,胡豫,杨焰,等.脑梗死与血浆D-二聚体/纤维蛋白原比值的关系[J].临床血液学杂志,2006,19(4):216-217.]
[22]Huang YC,Bassett MA,Levin D,et al.Acute phase reaction in healthy volunteers after bronchoscopy with lavage[J].Chest,2006,129(6):1565-1569.
[2]Empana JP,Canoui-Poitrine F,Luc G,et al.Contribution of novel biomarkers to incident stable angina and acute coronary syndrome:the PRIME Study[J].Eur Heart J,2008,29(16):1966-1974.
[3]Zhang Y,Ji HM,Wang FY,et al.Changes and clinical significance of serum adiponectin,fibrinogen and D-dimer in patients with acute coronary syndrome[J].Shaanxi Med J,2014,43(8):1044-1046.[张勇,吉海明,王芳云,等.急性冠脉综合征患者血清脂联素、纤维蛋白原和D-二聚体的变化及临床意义[J].陕西医学杂志,2014,43(8):1044-1046.]
[4]Song YX,Zhao XY,Wang XF,et al.Relationship between neutrophils to lymphocyte ratio,D-dimer and coronary artery stenosis degree in patients with acute coronary syndrome[J].JZhengzhou Univ(Med Sci),2016,51(6):780-784.[宋雅信,赵晓燕,王小芳,等.中性粒细胞-淋巴细胞比值及D-二聚体与急性冠脉综合征冠脉狭窄程度的关系[J].郑州大学学报(医学版),2016,51(6):780-784.]
[5]Wuillemin WA,Korte W,Waser G,et al.Usefulness of the D-dimer/fibrinogen ratio to predict deep venous thrombosis[J].J Thromb Haemost,2005,3(2):385-387.
[6]Alvarez-Perez FJ,Castelo-Branco M,Alvarez-Sabin J.Usefulness of measurement of fibrinogen,D-dimer,D-dimer/fibrinogen ratio,C reactive protein and erythrocyte sedimentation rate to assess the pathophysiology and mechanism of ischaemic stroke[J].J Neurol Neurosurg Psychiatry,2011,82(9):986-992.
[7]Kucher N,Kohler HP,Dornhofer T,et al.Accuracy of D-dimer/fibrinogen ratio to predict pulmonary embolism:a prospective diagnostic study[J].J Thromb Haemost,2003,1(4):708-713.
[8]Montalescot G,Sechtem U,Achenbach S,et al.2013 ESCguidelines on the management of stable coronary artery disease:the task force on the management of stable coronary artery disease of the European Society of Cardiology[J].Eur Heart J,2013,34(38):2949-3003.
[9]Cannon CP,Brindis RG,Chaitman BR,et al.2013 ACCF/AHAkey data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes and coronary artery disease:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards(Writing Committee to Develop Acute Coronary Syndromes and Coronary Artery Disease Clinical Data Standards)[J].Circulation,2013,127(9):1052-1089.
[10]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51(3):606.
[11]Rafieian-Kopaei M,Setorki M,Doudi M,et al.Atherosclerosis:process,indicators,risk factors and new hopes[J].Int J Prev Med,2014,5(8):927-946.
[12]Chew DP,Bhatt DL,Robbins MA,et al.Incremental prognostic value of elevated baseline C-reactive protein among established markers of risk in percutaneous coronary intervention[J].Circulation,2001,104(9):992-997.
[13]Guo F,Liu JT.The research progress of the relationship between fibrinogen and atherosclerosis[J].Prog Physiol Sci,2009,40(2):169-171.[郭芳,刘俊田.纤维蛋白(原)与动脉粥样硬化关系的研究进展[J].生理科学进展,2009,40(2):169-171.]
[14]Montalescot G,Collet JP,Choussat R,et al.Fibrinogen as a risk factor for coronary heart disease[J].Eur Heart J,1998,19(Suppl H):H11-H17.
[15]Biasucci LM.CDC/AHA Workshop on markers of inflammation and cardiovascular disease:application to clinical and public health practice:clinical use of inflammatory markers in patients with cardiovascular diseases:a background paper[J].Circulation,2004,110(25):e560-e567.
[16]Borissoff JI,Spronk HM,Ten CH.The hemostatic system as a modulator of atherosclerosis[J].N Engl J Med,2011,364(18):1746-1760.
[17]Bayes-Genis A,Mateo J,Santalo M,et al.D-Dimer is an early diagnostic marker of coronary ischemia in patients with chest pain[J].Am Heart J,2000,140(3):379-384.
[18]Hajsadeghi S,Kerman SR,Khojandi M,et al.Accuracy of D-dimer:fibrinogen ratio to diagnose pulmonary thromboembolism in patients admitted to intensive care units[J].Cardiovasc J Afr,2012,23(8):446-456.
[19]Kara H,Bayir A,Degirmenci S,et al.D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department[J].Acta Clin Belg,2014,69(4):240-245.
[20]Wang XD.The diagnosis value of D-dimer and fibrinogen ratio in deep vein thrombosis[J].J Pract Med Tech,2014,21(7):744-746.[王旭东.D-二聚体与纤维蛋白原比值在下肢深静脉血栓诊断中的应用价值[J].实用医技杂志,2014,21(7):744-746.]
[21]Zhang XP,Hu Y,Yang Y,et al.Relationship between cerebral infarction and D-dimer/Fibrinogen ratio[J].J Clin Hematol,2006,19(4):216-217.[张小平,胡豫,杨焰,等.脑梗死与血浆D-二聚体/纤维蛋白原比值的关系[J].临床血液学杂志,2006,19(4):216-217.]
[22]Huang YC,Bassett MA,Levin D,et al.Acute phase reaction in healthy volunteers after bronchoscopy with lavage[J].Chest,2006,129(6):1565-1569.