冠心病患者血浆凝血、纤溶检测指标与低密度脂蛋白水平的相关性研究
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摘要
目的:筛选可能协助低密度脂蛋白(LDL)预测冠心病准确性的血浆凝血与纤溶检测指标。方法:经心血管造影确诊的冠心病患者115例,平均年龄(61.78±5.60)岁;健康对照组50例,平均年龄(50.40±7.60)岁。使用SIEMENS ADVIA-2400全自动生化分析仪测定LDL水平,全面测定包括凝血酶抗凝血酶复合物(TAT)、血栓调节蛋白(TM)、纤溶酶-纤溶酶抑制物复合物(PIC)、组织型纤溶酶原激活剂及其抑制剂复合物(tPAIC)在内的凝血与纤溶检测指标,分别分析它们与LDL之间的相关性。结果:冠心病组血浆TM、tPAIC及LDL水平显著高于健康对照组(P值分别为0.004,0.000,0.04),TAT及PIC水平二者之间的差异无统计学意义。二分类变量的Logistic回归分析结果显示,各指标对是否患冠心病预测能力相似。Pearson相关分析结果表明,TM与LDL存在显著负相关(r=-0.195),其它指标与LDL不相关。结论:血浆TM水平的检测可能可以用来进一步研究协助LDL水平对冠心病预测的准确性。
Objective: To screen indexes for helping serum low density lipoprotein(LDL) levels to predict coronary artery disease(CAD) in plasma coagulation and fibrinolysis tests. Methods: A total of 115 cases of confirmed patients with CAD identified by coronary angiography and 20 cases of physical examination persons were collected. The mean age were respectively(61.78 ± 5.60) and(50.40 ± 7.60)years. The relationships among CAD, LDL and TAT, TM, PIC, and tPAIC levels were analyzed.Results: The levels of plasma TM, Tpaic, and LDL in the coronary heart disease group were significantly higher than those in the healthy control group(P=0.004,0.000,0.04, respectively). There was no significant difference in TM and PIC levels between the two groups. The results of binary logistic regression analysis showed that each index had similar ability to predict coronary heart disease. The results of Pearson correlation analysis showed that there was a significantly negative correlation between TM and LDL(r=-0.195), and other indicators were not related to LDL. Conclusion: The detection of plasma TM level may have potential to improve the accuracy for helping LDL level to predict CAD.
Objective: To screen indexes for helping serum low density lipoprotein(LDL) levels to predict coronary artery disease(CAD) in plasma coagulation and fibrinolysis tests. Methods: A total of 115 cases of confirmed patients with CAD identified by coronary angiography and 20 cases of physical examination persons were collected. The mean age were respectively(61.78 ± 5.60) and(50.40 ± 7.60)years. The relationships among CAD, LDL and TAT, TM, PIC, and tPAIC levels were analyzed.Results: The levels of plasma TM, Tpaic, and LDL in the coronary heart disease group were significantly higher than those in the healthy control group(P=0.004,0.000,0.04, respectively). There was no significant difference in TM and PIC levels between the two groups. The results of binary logistic regression analysis showed that each index had similar ability to predict coronary heart disease. The results of Pearson correlation analysis showed that there was a significantly negative correlation between TM and LDL(r=-0.195), and other indicators were not related to LDL. Conclusion: The detection of plasma TM level may have potential to improve the accuracy for helping LDL level to predict CAD.
引文
[1]Steinberg D.The LDL modification hypothesis of ath-erogenesis:an update[J].J Lipid Res,2009,50(Suppl):S376-S381.
[2]熊旭光,唐其柱,刘文卫.凝血酶-抗凝血酶复合物及D-二聚体在冠心病早期诊断中的价值[J].实用老年医学,2015,29(2):131-133.Xiong XG,Tang QZ,Liu WW.Value of thrombin-antithrombin complex,D-dimer in the early diagnosis for coronary artery disease[J].Pract Geriatr,2015,29(2):131-133.
[3]覃方生,陈聿峰,覃宋强,等.冠心病患者血栓调节蛋白与C反应蛋白的相关性研究[J].广西医学,2015,37(11):1 659-1 660.Qin FS,Chen YF,Qin SQ,et al.Correlation between thrombomodulin and C reactive protein in patients with coronary heart disease[J].Guangxi Medicine,2015,37(11):1 659-1 660.
[4]Negreva M,Georgiev S,Prodanova K,et al.Early changes in the antithrombin and thrombin-antithrombin complex in patients with paroxysmal atrial fibrillation[J].Cardiol Res,2016,7(3):89-94.
[5]Wada T,Gando S,Mizugaki A,et al.Coagulofibrinolytic changes in patients with disseminated intravascular coagulation associated with post-cardiac arrest syndrome--fibrinolytic shutdown and insufficient activation of fibrinolysis Lead to organ dysfunction[J].Thromb Res,2013,132(1):e64-e69.
[6]Conway EM.Thrombomodulin and its role in inflammation[J].Semin Immunopathol,2012,34(1):107-125.
[7]黄玉艳,黄全跃.血浆凝血酶-抗凝血酶Ⅲ复合物水平对非瓣膜性房颤和慢性心力衰竭患者临床意义[J].实用预防医学,2012,19(5):752-754.Huang YY,Huang QY.Study on the clinic signifieance of plasma thrombin-antithrombinⅢcomplexs level in patients with non-valvular atrial fibrillation and chronic heart failure[J].Practical Preventive Medicine,2012,19(5):752-754.
[8]Fadel FL,Elshamaa MF,Abdel-Rahman SM,et al.Coagulation,thrombophilia and patency of arteriovenous fistula in children undergoing haemodialysis com-pared with healthy volunteers:a prospective analysis[J].Blood Coagul Fibrinolysis,2016,27(2):190-198.
[9]苑姗姗,荣瑗瑗.血栓调节蛋白与冠心病的研究进展[J].中国循证心血管医学杂志,2015,7(4):568-571.Yuan SS,Rong YY.Research progress of thrombomodulin and coronary heart disease[J].Chin J Evid Based Cardiovasc Med,2015,7(4):568-571.
[10]李雪美,江淼,赵益明.血管性血友病因子的研究进展[J].中国实验血液学杂志,2013,21(3):801-805.Li XM,Jiang M,Zhao YM.Research advance in von Willebrand factor[J].Journal of Experimental Hematology,2013,21(3):801-805.
[11]吕永楠,任玮,陈晶晶,等.急性心肌梗死患者血栓标志物水平变化及意义[J].微循环学杂志,2017,27(3):43-46.LüYN,Ren W,Chen JJ,et al.Clinical significance of blood coagulation biomarkers in patients with acute myocardial infarction[J].Chinese Journal of Microcirculation,2017,27(3):43-46.
[12]Valente-Acosta B,Banos-Gonzalez MA,Pena-Duque MA,et al.Association between stable coronary artery disease and in vivo thrombin generation[J].Cardiol Res Pract,2016,2016:5149825.
[13]Borissoff JI,Joosen IA,Versteylen MO,et al.Acce-lerated in vivo thrombin formation independently predicts the presence and severity of CT angiographic coronary atherosclerosis[J].JACC Cardiovasc Imaging,2012,5(12):1 201-1 210.
[14]John S,Drobnik W,Lackner K,et al.Soluble thrombomodulin and endothelial dysfunction in early atherosclerosis[J].Lancet,1999,354(9 190):1 647-1 647.
[2]熊旭光,唐其柱,刘文卫.凝血酶-抗凝血酶复合物及D-二聚体在冠心病早期诊断中的价值[J].实用老年医学,2015,29(2):131-133.Xiong XG,Tang QZ,Liu WW.Value of thrombin-antithrombin complex,D-dimer in the early diagnosis for coronary artery disease[J].Pract Geriatr,2015,29(2):131-133.
[3]覃方生,陈聿峰,覃宋强,等.冠心病患者血栓调节蛋白与C反应蛋白的相关性研究[J].广西医学,2015,37(11):1 659-1 660.Qin FS,Chen YF,Qin SQ,et al.Correlation between thrombomodulin and C reactive protein in patients with coronary heart disease[J].Guangxi Medicine,2015,37(11):1 659-1 660.
[4]Negreva M,Georgiev S,Prodanova K,et al.Early changes in the antithrombin and thrombin-antithrombin complex in patients with paroxysmal atrial fibrillation[J].Cardiol Res,2016,7(3):89-94.
[5]Wada T,Gando S,Mizugaki A,et al.Coagulofibrinolytic changes in patients with disseminated intravascular coagulation associated with post-cardiac arrest syndrome--fibrinolytic shutdown and insufficient activation of fibrinolysis Lead to organ dysfunction[J].Thromb Res,2013,132(1):e64-e69.
[6]Conway EM.Thrombomodulin and its role in inflammation[J].Semin Immunopathol,2012,34(1):107-125.
[7]黄玉艳,黄全跃.血浆凝血酶-抗凝血酶Ⅲ复合物水平对非瓣膜性房颤和慢性心力衰竭患者临床意义[J].实用预防医学,2012,19(5):752-754.Huang YY,Huang QY.Study on the clinic signifieance of plasma thrombin-antithrombinⅢcomplexs level in patients with non-valvular atrial fibrillation and chronic heart failure[J].Practical Preventive Medicine,2012,19(5):752-754.
[8]Fadel FL,Elshamaa MF,Abdel-Rahman SM,et al.Coagulation,thrombophilia and patency of arteriovenous fistula in children undergoing haemodialysis com-pared with healthy volunteers:a prospective analysis[J].Blood Coagul Fibrinolysis,2016,27(2):190-198.
[9]苑姗姗,荣瑗瑗.血栓调节蛋白与冠心病的研究进展[J].中国循证心血管医学杂志,2015,7(4):568-571.Yuan SS,Rong YY.Research progress of thrombomodulin and coronary heart disease[J].Chin J Evid Based Cardiovasc Med,2015,7(4):568-571.
[10]李雪美,江淼,赵益明.血管性血友病因子的研究进展[J].中国实验血液学杂志,2013,21(3):801-805.Li XM,Jiang M,Zhao YM.Research advance in von Willebrand factor[J].Journal of Experimental Hematology,2013,21(3):801-805.
[11]吕永楠,任玮,陈晶晶,等.急性心肌梗死患者血栓标志物水平变化及意义[J].微循环学杂志,2017,27(3):43-46.LüYN,Ren W,Chen JJ,et al.Clinical significance of blood coagulation biomarkers in patients with acute myocardial infarction[J].Chinese Journal of Microcirculation,2017,27(3):43-46.
[12]Valente-Acosta B,Banos-Gonzalez MA,Pena-Duque MA,et al.Association between stable coronary artery disease and in vivo thrombin generation[J].Cardiol Res Pract,2016,2016:5149825.
[13]Borissoff JI,Joosen IA,Versteylen MO,et al.Acce-lerated in vivo thrombin formation independently predicts the presence and severity of CT angiographic coronary atherosclerosis[J].JACC Cardiovasc Imaging,2012,5(12):1 201-1 210.
[14]John S,Drobnik W,Lackner K,et al.Soluble thrombomodulin and endothelial dysfunction in early atherosclerosis[J].Lancet,1999,354(9 190):1 647-1 647.