纤维蛋白原与急性冠脉综合征及其危险严重程度的相关性研究

发布时间：2018-04-09 04:09

本文选题：急性冠脉综合征　切入点：纤维蛋白原　出处：《广西医科大学》2015年硕士论文

【摘要】：目的：急性冠脉综合征临床表现各异,冠状动脉狭窄严重程度不一,血流动力学变化差异大,病死率高,预后存在明显差异。血清纤维蛋白原作为心血管事件的一个预测因素,与冠心病的发生、发展相关。本研究目的为探究纤维蛋白原与急性冠脉综合征的发生、发展及危险严重程度的关系。方法：纳入符合急性冠脉综合征(ACS)诊断标准的患者共692例,拟诊“冠心病”但后冠状动脉造影显示冠状动脉光滑无斑块或狭窄患者作为对照组99例。对患者的一般情况(如年龄、性别、吸烟史、吸烟史、高血压史等)进行详细记录。同时测定血清纤维蛋白原(FIB)水平、血脂、血糖及其他血清学指标.所有患者均完善心电图、冠脉造影检查,冠脉狭窄程度以gensini评分评价,急性冠脉综合症危险程度以grace评分评价。分析不同急性冠脉综合征类型、冠脉病变支数、gensini评分及grace评分组间血清纤维蛋白原(FIB)水平,探讨血清纤维蛋白原与急性冠脉综合征的发生、发展、冠脉严重程度及危险程度的相关性。结果：1、STEMI组血清纤维蛋白原水平明显高于NST-ACS组及正常组,NST-ACS组血清FIB水平又明显高于正常组。2、血清纤维蛋白原水平与冠脉病变支数有关,冠脉多支病变组双支病变组单支病变组正常组。3、与低gensini评分组患者相比,高gensini评分组血清纤维蛋白原水平明显增高,随着gensini评分的增加,血清FIB水平逐渐增高。4、随着grace评分的增高,血清纤维蛋白原水平显著升高。5、相关分析提示,血清纤维蛋白原与grace评分及gensini评分呈正相关性。6、多因素logistic回归分析示,血清纤维蛋白原是急性冠脉综合征危险程度加重的独立因素(P0.05)。7、血清纤维蛋白原诊断急性冠脉综合征的ROC曲线下面积为0.876,提示纤维蛋白原对预测急性冠脉综合征的发生有一定价值,以FIB水平4.15g/l为标准,从统计学意义上讲诊断冠心病的敏感性、特异性分别为80.1%、79.9%。结论：1、血清纤维蛋白原水平能反映冠脉病变严重程度及急性冠脉综合征的危险程度；2、血清纤维蛋白原与急性冠状动脉综合征的发生、发展密切相关,是急性冠脉综合征危险程度加重的独立因素。3、血清纤维蛋白原可用于预测急性冠脉综合征的发生风险。4、联合运用血清纤维蛋白原水平可能对ACS的早期危险分层、预后评估及诊疗方案的选择有重要临床参考价值。
[Abstract]:Objective: acute coronary syndrome (ACS) is characterized by different clinical manifestations, different severity of coronary stenosis, great difference in hemodynamics, high mortality and significant difference in prognosis.As a predictor of cardiovascular events, serum fibrinogen is associated with the occurrence and development of coronary heart disease.The aim of this study was to investigate the relationship between fibrinogen and the occurrence, development and risk severity of acute coronary syndrome (ACS).Methods: a total of 692 patients with acute coronary syndrome (ACS) were included in this study. 99 patients with coronary artery disease were diagnosed as "coronary artery disease", but the patients with smooth coronary artery without plaque or stenosis were selected as the control group.The patient's general information (such as age, sex, smoking history, smoking history, hypertension history, etc.) was recorded in detail.At the same time, serum fibrinogen FIBs, blood lipids, blood glucose and other serological indexes were measured.All patients had improved ECG, coronary angiography, coronary stenosis was evaluated by gensini score, and acute coronary syndrome risk was evaluated by grace score.The types of acute coronary syndrome (ACS), the levels of serum fibrinogen (FB) and the levels of serum fibrinogen (FB) in patients with acute coronary syndrome (ACS) were analyzed, and the occurrence and development of acute coronary syndrome (ACS) were discussed.Correlation between severity and risk of coronary artery.Results the level of serum fibrinogen in group 1 was significantly higher than that in group NST-ACS and group NST-ACS, and the level of serum fibrinogen was significantly higher than that in group 2. The level of serum fibrinogen was related to the number of coronary artery lesion branches.Compared with the low gensini score group, the serum fibrinogen level in the high gensini score group was significantly higher than that in the single vessel lesion group, and the level of fibrinogen in the high gensini score group increased with the increase of gensini score.The serum FIB level increased gradually. With the increase of grace score, the serum fibrinogen level increased significantly. The correlation analysis indicated that the serum fibrinogen level was positively correlated with the grace score and gensini score. The multivariate logistic regression analysis showed that the serum fibrinogen level was significantly higher than that in the control group.Serum fibrinogen is an independent factor for exacerbating the risk of acute coronary syndrome (ACS). The area under the ROC curve of serum fibrinogen for diagnosis of acute coronary syndrome is 0.876, suggesting that fibrinogen can predict acute coronary syndrome.It has some value.According to the standard of FIB level 4.15g/l, the sensitivity of diagnosis of coronary heart disease was 80.1% and 79.9% respectively.Conclusion the level of serum fibrinogen can reflect the severity of coronary artery disease and the risk of acute coronary syndrome. Serum fibrinogen is closely related to the occurrence and development of acute coronary syndrome.Serum fibrinogen can be used to predict the risk of acute coronary syndrome. Combined use of serum fibrinogen may be an early risk stratification of ACS.The evaluation of prognosis and the choice of diagnosis and treatment plan have important clinical reference value.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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