血浆纤维蛋白原和载脂蛋白AⅠ水平与急性冠脉综合征患者PCI术后近期预后的相关性研究
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摘要
目的:通过观察行PCI( percutaneous coronary intervention, PCI)术的急性冠脉综合征(acute coronary syndrome ,ACS)患者血浆纤维蛋白原(Fibrinogen,FIB)及载脂蛋白AⅠ(Apolipoprotein AⅠ,ApoAⅠ)水平与患者PCI术后30天内不良心血管事件(Major adwerse cardiacevents,MACE)发生率的关系,探讨用FIB及ApoAⅠ水平对ACS患者PCI术后近期预后进行预测的可能性,为指导ACS治疗提供理论依据。
方法:测定121例入院后行PCI术的ACS患者和64例健康者的血浆FIB、ApoAⅠ和ApoB水平,并记录患者的一般资料。ACS患者按照血清心肌标志物水平分为不稳定心绞痛(unstable angina,UA)组(n=53)和急性心肌梗死(acute myocardial infarction,AMI)组(n=68),比较它们与健康者的FIB、ApoAⅠ和ApoAⅠ/ ApoB比值的情况。根据FIB水平将所有ACS患者分为:Ⅰ组(n=83):FIB<4g/l,Ⅱ组(n=38):FIB≥4g/l;按ApoAⅠ水平将所有ACS患者分为:Ⅲ组(n=78): ApoAⅠ≥1.0 g/l;Ⅳ组(n=43): ApoAⅠ<1.0 g/l。分别比较Ⅰ组和Ⅱ组,Ⅲ组和Ⅳ组患者PCI术后30天的主要MACE(包括PCI术中恶性心律失常、术中无复流、PCI术中慢复流及PCI术后心绞痛、严重心律失常、充血性心力衰竭、心室壁瘤、心源性休克、死亡)的发生情况,分析影响ACS患者PCI术后近期预后的危险因素。
结果:
1. AMI组FIB水平显著高于UA组和对照组(P<0.01);而UA组和对照组之间无统计学差异(P>0.05)。AMI组与UA组同对照组比较ApoAⅠ明显降低(P<0.01),而AMI组ApoAⅠ水平显著低于UA组(P<0.05)。
2.AMI组与UA组分别同对照组比较ApoAⅠ/ApoB的比值有显著差异(P<0.01),而AMI组与UA组比较无统计学差异( P>0.05)。
3.在PCI术后不良MACE中,Ⅱ组与Ⅰ组比较在严重心律失常、充血性心力衰竭、心室壁瘤、心源性休克的发生率明显增加,有统计学差异(P<0.05)。Ⅳ组与Ⅲ组比较在充血性心力衰竭发生率上明显增加,有统计学差异(P<0.05);Ⅱ组与Ⅰ组比较,Ⅳ组与Ⅲ组比较总事件率均有显著差异(P<0.01)。
结论:
1.AMI患者FIB水平显著升高,而UA患者FIB水平无明显升高。
2. ACS患者ApoAⅠ水平及ApoAⅠ/ApoB比值显著降低,是其主要的危险因素。
3.FIB≥4g/l者,ApoAⅠ<1.0g/l者PCI术后近期发生不良MACE显著高于与其比较的Ⅰ组和Ⅲ组,提示FIB和ApoAⅠ水平是影响ACS患者PCI术后近期预后的主要危险因素。
Objective:The purpose of this study was to investigate the possibility of the prediction about the short-term prognosis of patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI) by Fibrinogen(FIB) and Apolipoprote AⅠ( ApoAⅠ) so as to provide a theoret-ical basis for ACS treatment by observing the relationship between FIB and ApoAⅠlevel of the patients with ACS who received PCI and the incidence rate of patients’major adwerse cardiac events(MACE) within 30 days after PCI.
Methods: Measurements the FIB, ApoAⅠand ApoB level of 121 subjects with ACS who received PCI after admission and 64 healthy subjects, and record the patients’general information as well. According to the serum cardiac markers level, ACS patients were divided into two groups: unstable angina(UA) group (n = 53) and acute myocardial infarction(AMI) group (n = 68), comparing them with healthy persons’FIB, ApoAⅠand ApoAⅠ/ ApoB ratio. According to FIB level, ACS patients were divided into two groups: GroupⅠ(n = 83): FIB<4g/l;GroupⅡ(n = 38): FIB≥4g / l; According to the ApoAⅠlevel ,they were divide into another two groups: GroupⅠ(n = 78): ApoAⅠ≥1.0 g / l; GroupⅣ(n = 43) ApoAⅠ<1.0 g/l. We compare the occurrence of the patients’MACE(including malignant arrhythmia, no reflow, slow reflow during PCI and angina pectoris, severe arrhythmia, congestive heart failure, ventricular aneurysm, cardiac shock, death after PCI ) after PCI for 30 days between GroupⅠand GroupⅡ,and between GroupⅠand GroupⅣrespectively. So we can analyze the risk factors which influence the short-term prognosis of patients with ACS after PCI.
Results:
1. AMI group’s FIB level was significantly higher than that of FIB UA group and the control group (P<0.01);And the UA group and the control group showed no statistically significant difference(P>0.05).Comparing UA group , AMI group with the control group, we found ApoAⅠsignificantly lower (P<0.01), while the AMI group’s ApoAⅠlevel was significantly lower than that of UA group (P<0.05).
2.We made AMI group and UA group compare with control group, finding that ApoAⅠ/ApoB ratio between them had significant difference(P<0.01).While the comparison of AMI group and UA group had no statistically significant difference(P>0.05).
3. Concerning some elements of MACE(including severe arrhythmia, congestive heart failure, ventricular aneurysm, cardiac shock, death after PCI ) after PCI, GroupⅡ’s incidence rate was increased more than that of GroupⅠ, but GroupⅣwith congestive heart failure element was increased more than that of GroupⅠ(P<0.05).The total MACE incidence rate between GroupⅡand GroupⅠ, GroupⅣand GroupⅠhad both a significant difference in statistics. (P<0.01).
Conclusion:
1. FIB level in patients with AMI is significantly raised, and FIB level is not significantly raised in patients with UA.
2. ACS patients’ApoAⅠlevel and ApoAⅠ/ ApoB ratio are significantly lower, which is the main risk factors.
3.The one with FIB≥4g / l and ApoAⅠ<1.0g/l, who may occur MACE after PCI has a significantly higher rate than that of the control group, suggesting that FIB and ApoAⅠlevel are the major risk factors to influence the short-term prognosis of patients with ACS after PCI.
方法:测定121例入院后行PCI术的ACS患者和64例健康者的血浆FIB、ApoAⅠ和ApoB水平,并记录患者的一般资料。ACS患者按照血清心肌标志物水平分为不稳定心绞痛(unstable angina,UA)组(n=53)和急性心肌梗死(acute myocardial infarction,AMI)组(n=68),比较它们与健康者的FIB、ApoAⅠ和ApoAⅠ/ ApoB比值的情况。根据FIB水平将所有ACS患者分为:Ⅰ组(n=83):FIB<4g/l,Ⅱ组(n=38):FIB≥4g/l;按ApoAⅠ水平将所有ACS患者分为:Ⅲ组(n=78): ApoAⅠ≥1.0 g/l;Ⅳ组(n=43): ApoAⅠ<1.0 g/l。分别比较Ⅰ组和Ⅱ组,Ⅲ组和Ⅳ组患者PCI术后30天的主要MACE(包括PCI术中恶性心律失常、术中无复流、PCI术中慢复流及PCI术后心绞痛、严重心律失常、充血性心力衰竭、心室壁瘤、心源性休克、死亡)的发生情况,分析影响ACS患者PCI术后近期预后的危险因素。
结果:
1. AMI组FIB水平显著高于UA组和对照组(P<0.01);而UA组和对照组之间无统计学差异(P>0.05)。AMI组与UA组同对照组比较ApoAⅠ明显降低(P<0.01),而AMI组ApoAⅠ水平显著低于UA组(P<0.05)。
2.AMI组与UA组分别同对照组比较ApoAⅠ/ApoB的比值有显著差异(P<0.01),而AMI组与UA组比较无统计学差异( P>0.05)。
3.在PCI术后不良MACE中,Ⅱ组与Ⅰ组比较在严重心律失常、充血性心力衰竭、心室壁瘤、心源性休克的发生率明显增加,有统计学差异(P<0.05)。Ⅳ组与Ⅲ组比较在充血性心力衰竭发生率上明显增加,有统计学差异(P<0.05);Ⅱ组与Ⅰ组比较,Ⅳ组与Ⅲ组比较总事件率均有显著差异(P<0.01)。
结论:
1.AMI患者FIB水平显著升高,而UA患者FIB水平无明显升高。
2. ACS患者ApoAⅠ水平及ApoAⅠ/ApoB比值显著降低,是其主要的危险因素。
3.FIB≥4g/l者,ApoAⅠ<1.0g/l者PCI术后近期发生不良MACE显著高于与其比较的Ⅰ组和Ⅲ组,提示FIB和ApoAⅠ水平是影响ACS患者PCI术后近期预后的主要危险因素。
Objective:The purpose of this study was to investigate the possibility of the prediction about the short-term prognosis of patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI) by Fibrinogen(FIB) and Apolipoprote AⅠ( ApoAⅠ) so as to provide a theoret-ical basis for ACS treatment by observing the relationship between FIB and ApoAⅠlevel of the patients with ACS who received PCI and the incidence rate of patients’major adwerse cardiac events(MACE) within 30 days after PCI.
Methods: Measurements the FIB, ApoAⅠand ApoB level of 121 subjects with ACS who received PCI after admission and 64 healthy subjects, and record the patients’general information as well. According to the serum cardiac markers level, ACS patients were divided into two groups: unstable angina(UA) group (n = 53) and acute myocardial infarction(AMI) group (n = 68), comparing them with healthy persons’FIB, ApoAⅠand ApoAⅠ/ ApoB ratio. According to FIB level, ACS patients were divided into two groups: GroupⅠ(n = 83): FIB<4g/l;GroupⅡ(n = 38): FIB≥4g / l; According to the ApoAⅠlevel ,they were divide into another two groups: GroupⅠ(n = 78): ApoAⅠ≥1.0 g / l; GroupⅣ(n = 43) ApoAⅠ<1.0 g/l. We compare the occurrence of the patients’MACE(including malignant arrhythmia, no reflow, slow reflow during PCI and angina pectoris, severe arrhythmia, congestive heart failure, ventricular aneurysm, cardiac shock, death after PCI ) after PCI for 30 days between GroupⅠand GroupⅡ,and between GroupⅠand GroupⅣrespectively. So we can analyze the risk factors which influence the short-term prognosis of patients with ACS after PCI.
Results:
1. AMI group’s FIB level was significantly higher than that of FIB UA group and the control group (P<0.01);And the UA group and the control group showed no statistically significant difference(P>0.05).Comparing UA group , AMI group with the control group, we found ApoAⅠsignificantly lower (P<0.01), while the AMI group’s ApoAⅠlevel was significantly lower than that of UA group (P<0.05).
2.We made AMI group and UA group compare with control group, finding that ApoAⅠ/ApoB ratio between them had significant difference(P<0.01).While the comparison of AMI group and UA group had no statistically significant difference(P>0.05).
3. Concerning some elements of MACE(including severe arrhythmia, congestive heart failure, ventricular aneurysm, cardiac shock, death after PCI ) after PCI, GroupⅡ’s incidence rate was increased more than that of GroupⅠ, but GroupⅣwith congestive heart failure element was increased more than that of GroupⅠ(P<0.05).The total MACE incidence rate between GroupⅡand GroupⅠ, GroupⅣand GroupⅠhad both a significant difference in statistics. (P<0.01).
Conclusion:
1. FIB level in patients with AMI is significantly raised, and FIB level is not significantly raised in patients with UA.
2. ACS patients’ApoAⅠlevel and ApoAⅠ/ ApoB ratio are significantly lower, which is the main risk factors.
3.The one with FIB≥4g / l and ApoAⅠ<1.0g/l, who may occur MACE after PCI has a significantly higher rate than that of the control group, suggesting that FIB and ApoAⅠlevel are the major risk factors to influence the short-term prognosis of patients with ACS after PCI.
引文
1.Correale M,Brunetti ND,Gennaro L,et al.Acute phase proteins in therosclerosis (acute coronary syndrome).Cardiovasc Hematol Agents Med Chem,2008,6:272-277.
2.何上洪,黄艺群,向上等.急性冠脉综合征患者血浆纤维蛋白原的测定极其意义[J].中华现代医学杂志,2004,14(12):134-137.
3.COPPOLA G,RIZZO M,ABRIGNANI M G,et al.Fibrinogen as a predictor of mortality after acute myocardial infarction:a forty-two-month follow-up study[J].Ital Heart J,2005,6:315-322.
4.Guo M, Sahni SK, Sahni A,et al.Fibrinogen regulates the expression of inflammatory through NK-kappa Bactivation of endothelial cells [J].Thromb Haemost ,2004,92:858-866.
5.吴霞,彭朝权,宋立功.纤维蛋白原浓度变化在急性冠脉综合征中的临床意义[J].心血管康复杂志,2004,13(1):79-80.
6.Lau DH,Huynh LT,Chew DP,et a1.Prognostic impact of types of arterial fibrillation in acute coronary syndromes [J]. Am J Cardiol, 2009, 104(10): 17 - 23.
7.黄广用.纤维蛋白原与心血管疾病[J].中国慢性疾病预防与控制,1999,7(4):191-193.
8.胡泽平,王邦宁.急性冠脉综合征患者血胆红素、纤维蛋白原、脂蛋白(a)的变化及冠脉病变的关系[J].陕西医学杂志,2010,39(4):423-425.
9.Shojaie M,Pourahmad M,Eshraghian A.Fibrinogen as a risk factor for premature myocardial infarction in Iranian patients:a case control study[J].Vasc Health Risk Manag,2009,5(1):673.
10.吕志前,黄体钢.血脂脂蛋白预示冠心病的研究[J].实用医学杂志,1999,4:31-32
11.Barrter P,Kastelien J,Nunn A,et al.High Density lipoprotein(HDLS)and at heroselerosis:the unanswered questions.AT herosclerosis,2003,168:195-211.
12.Witztum JL. Role of oxidized LDL in atherogenesis. Br Heart J,1993,69:512-514.
13.Anber V,Griffin BA,McConnell M,et al. Influence of plasma lipid and LDL subfraction profile on the interaction between low density lipoproteinWith human arterial wall proteoglycans.Ather- osclerosis,1996,124(2):261-271.
14.Sniderman AD,Furberg CD,Keech A, et al.Apolipoprotein versus lipids as indices of coronary risk and as targets for statin therapyn treapy treatment[J].Lancet,2003361:777.
15.纪秋尚,张运,杨晓静.急性心肌梗死炎症介质的动态变化及意义[J].中国动脉硬化杂志,2006,11(4):349-351.
16.Francis MC,Frohlich JJ.Coronary artery disease in patients at low risk:Apolipoprotein AI as an independent risk factor. Atherosclerosis,2001,155:165-170.
17.Packard CJ.Apolipoproteins:the new prognostic indicator?Eur hrart J,2003,5(Sup-p l.D):D9-D16.
18.Barter PJ,Kastelein JJ.Targeting cholesterol ester transfer protein for the prevention andmanagement of cardiovascular disease[J].JAm Coll Cardiol,2006 ,47(3) :492-499 .
19.Brown BG,Zhao XQ,Chait A,et a1.Simvastain and niacin,antioxidant vitamins,or the combination for the prevention of coronary disease[J].N Engl J Med,2001,345(22):1583-1592.
20.Forrester JS.Shah PK.Emerging strategies for increasing high density lipoprotein[J].Am J Cardiol,2006,98(11):1542-1549.
21.Mon talescotG, AnkriA, V icaut E, et al. Fibrinogen after coronary angioplasty as a risk factor for restenos is. Circu lation,1995, 92: 31-38.
22.Liu zzo G,BuffonA,BiasucciLM, et al.Enhan ced in flammatory response to coronary angioplasty in patients with severe unstable angina. Circu lation, 1998, 98: 2370-2376.
1.Correale M,Brunetti ND,Gennaro L,et al. Acute phase proteins in therosclerosis (acute coronary syndrome).Cardiovasc Hematol Agents Med Chem,2008,6:272-277.
2.何上洪,黄艺群,向上等.急性冠脉综合征患者血浆纤维蛋白原的测定极其意义[J].中华现代医学杂志,2004,14(12):134-137.
3.COPPOLA G,RIZZO M,ABRIGNANI M G,et al.Fibrinogen as a predictor of mortality after acute myocardial infarction:a forty-two-month follow-up stud[J].Ital Heart J,2005,6:315-322.
4.Guo M, Sahni SK, Sahni A,et al.Fibrinogen regulates the expression of inflammatory through NK-kappaB activation of endothelial cells [J].Thromb Haemost ,2004,92:858-866.
5.吴霞,彭朝权,宋立功.纤维蛋白原浓度变化在急性冠脉综合征中的临床意义[J].心血管康复杂志,2004,13(1):79-80.
6.Lau DH,Huynh LT,Chew DP,et a1.Prognostic impact of types of arterial fibrillation in acute coronary syndromes [J]. Am J Cardiol, 2009, 104(10): 17 - 23.
7.黄广用.纤维蛋白原与心血管疾病[J].中国慢性疾病预防与控制,1999,7(4):191-193.
8.胡泽平,王邦宁.急性冠脉综合征患者血胆红素、纤维蛋白原、脂蛋白(a)的变化及冠脉病变的关系[J].陕西医学杂志,2010,39(4):423-425.
9.Shojaie M,Pourahmad M,Eshraghian A.Fibrinogen as a risk factor for premature myocardial infarction in Iranian patients:a case control study[J].Vasc Health Risk Manag,2009,5(1):673
10.吕志前,黄体钢,血脂脂蛋白预示冠心病的研究[J].实用医学杂志,1999,4:31-32
11.Barrter P,Kastelien J,Nunn A,et al.High Density lipoprotein(HDLS)and at heroselerosis:the unanswered questions.AT herosclerosis,2003,168 :195 -211
12.Witztum JL.Role of oxidized LDL in atherogenesis.Br[J].Heart,1993,69: 512-514
13.Anber V,Griffin BA,McConnell M,et al. Influence of plasma lipid and LDL subfraction profile on the interaction between low density lipoprotein With human arterial wall proteoglycans.Ather- osclerosis,1996,124(2):261-271.
14.Sniderman AD,Furberg CD,Keech A, et al.Apolipoprotein versus lipids as indices of coronary risk and as targets for statin therapyn treapy treatment[J].Lancet,2003,361:777.
15.纪秋尚,张运,杨晓静.急性心肌梗死炎症介质的动态变化及意义[J].中国动脉硬化杂志,2006,11(4):349-351.
16.Francis MC,Frohlich JJ.Coronary artery disease in patients at low risk:Apolipopr- otein AI as an independent risk factor. Atherosclerosis,2001,155:165-170.
17.Packard CJ.Apolipoproteins:the new prognostic indicator?Eur hrart [J].2003,5(Suppl.D):D9-D16.
18.Barter PJ,Kastelein JJ.Targeting cholesterol ester transfer protein for the prevention andmanagement of cardiovascular disease[J].JAm Coll Cardiol,2006,47(3):492-499.
19.Brown BG,Zhao XQ,Chait A,et a1.Simvastain and niacin,antioxidant vitamins,or the combination for the prevention ofcoronary disease [J].N Engl J Med,2001,345(22):1583-1592.
20.Forrester JS,Shah PK.Emerging strategies for increasing high density lipoprotein[J].Am J Cardiol,2006 ,98(11) :1542-1549.
21.Mon talescotG, AnkriA, V icaut E, et al. Fibrinogen after coronary angioplasty as a risk factor for restenosis. Circulation,1995, 92: 31-38.
22.Liu zzo G,BuffonA, BiasucciLM, et al.Enhan ced in flammatory response to coronary angioplasty in patients with severe unstable-angina. Circu lation, 1998, 98: 2370-2376.
2.何上洪,黄艺群,向上等.急性冠脉综合征患者血浆纤维蛋白原的测定极其意义[J].中华现代医学杂志,2004,14(12):134-137.
3.COPPOLA G,RIZZO M,ABRIGNANI M G,et al.Fibrinogen as a predictor of mortality after acute myocardial infarction:a forty-two-month follow-up study[J].Ital Heart J,2005,6:315-322.
4.Guo M, Sahni SK, Sahni A,et al.Fibrinogen regulates the expression of inflammatory through NK-kappa Bactivation of endothelial cells [J].Thromb Haemost ,2004,92:858-866.
5.吴霞,彭朝权,宋立功.纤维蛋白原浓度变化在急性冠脉综合征中的临床意义[J].心血管康复杂志,2004,13(1):79-80.
6.Lau DH,Huynh LT,Chew DP,et a1.Prognostic impact of types of arterial fibrillation in acute coronary syndromes [J]. Am J Cardiol, 2009, 104(10): 17 - 23.
7.黄广用.纤维蛋白原与心血管疾病[J].中国慢性疾病预防与控制,1999,7(4):191-193.
8.胡泽平,王邦宁.急性冠脉综合征患者血胆红素、纤维蛋白原、脂蛋白(a)的变化及冠脉病变的关系[J].陕西医学杂志,2010,39(4):423-425.
9.Shojaie M,Pourahmad M,Eshraghian A.Fibrinogen as a risk factor for premature myocardial infarction in Iranian patients:a case control study[J].Vasc Health Risk Manag,2009,5(1):673.
10.吕志前,黄体钢.血脂脂蛋白预示冠心病的研究[J].实用医学杂志,1999,4:31-32
11.Barrter P,Kastelien J,Nunn A,et al.High Density lipoprotein(HDLS)and at heroselerosis:the unanswered questions.AT herosclerosis,2003,168:195-211.
12.Witztum JL. Role of oxidized LDL in atherogenesis. Br Heart J,1993,69:512-514.
13.Anber V,Griffin BA,McConnell M,et al. Influence of plasma lipid and LDL subfraction profile on the interaction between low density lipoproteinWith human arterial wall proteoglycans.Ather- osclerosis,1996,124(2):261-271.
14.Sniderman AD,Furberg CD,Keech A, et al.Apolipoprotein versus lipids as indices of coronary risk and as targets for statin therapyn treapy treatment[J].Lancet,2003361:777.
15.纪秋尚,张运,杨晓静.急性心肌梗死炎症介质的动态变化及意义[J].中国动脉硬化杂志,2006,11(4):349-351.
16.Francis MC,Frohlich JJ.Coronary artery disease in patients at low risk:Apolipoprotein AI as an independent risk factor. Atherosclerosis,2001,155:165-170.
17.Packard CJ.Apolipoproteins:the new prognostic indicator?Eur hrart J,2003,5(Sup-p l.D):D9-D16.
18.Barter PJ,Kastelein JJ.Targeting cholesterol ester transfer protein for the prevention andmanagement of cardiovascular disease[J].JAm Coll Cardiol,2006 ,47(3) :492-499 .
19.Brown BG,Zhao XQ,Chait A,et a1.Simvastain and niacin,antioxidant vitamins,or the combination for the prevention of coronary disease[J].N Engl J Med,2001,345(22):1583-1592.
20.Forrester JS.Shah PK.Emerging strategies for increasing high density lipoprotein[J].Am J Cardiol,2006,98(11):1542-1549.
21.Mon talescotG, AnkriA, V icaut E, et al. Fibrinogen after coronary angioplasty as a risk factor for restenos is. Circu lation,1995, 92: 31-38.
22.Liu zzo G,BuffonA,BiasucciLM, et al.Enhan ced in flammatory response to coronary angioplasty in patients with severe unstable angina. Circu lation, 1998, 98: 2370-2376.
1.Correale M,Brunetti ND,Gennaro L,et al. Acute phase proteins in therosclerosis (acute coronary syndrome).Cardiovasc Hematol Agents Med Chem,2008,6:272-277.
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