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目的:通过检测急性冠状动脉综合征(ACS)患者血浆Fn和Fg水平,探讨其与不同类型冠心病及冠状动脉狭窄程度之间的相关性及临床意义。方法:选取接受冠状动脉造影检查的患者88例。其中,ACS患者47例(ACS组),稳定型心绞痛(SAP)患者18例(SAP组)和冠状动脉造影正常对照者23例(Control组)。采用酶联免疫吸附法(ELISA)分别检测患者外周血浆Fn水平,凝血酶比浊法测定血浆Fg水平。根据冠状动脉造影结果,分为单支病变组、双支病变组及3支病变组,并结合改良的Gensini冠状动脉病变积分标准分别比较血浆Fn和Fg水平变化与冠状动脉管腔病变程度的相关性。结果:ACS组血浆Fn和Fg水平显著高于SAP组(P<0.01、P<0.05)及Control组(均P<0.01),SAP组血浆Fn和Fg水平亦高于Control组(均P<0.05)。血浆Fn水平在冠状动脉单支病变组、双支病变组及3支病变组之间差异无统计学意义(均P>0.05),而血浆Fg水平在冠状动脉3支病变组明显高于单支病变组(P<0.05)和双支病变组(P<0.01)。线性相关分析表明,血浆Fn与Fg水平具有明显相关性(r=0.381,P<0.01),血浆Fg水平分别与改良Gensini积分(r=0.322,P<0.01),VLDL-C(r=0.267,P<0.05)和lgLp(a)(r=0.349,P<0.01)水平呈正相关,而与ApoA1(r=-0.324,P<0.01)水平呈明显负相关,其他指标之间均无明显相关性。以所有研究对象的血浆Fn均数为界点,分成Fn≥290.37mg/L组和Fn<290.37mg/L组,分析2组间吸烟史、家族史、高血压史和糖尿病史的关系,结果除糖尿病病史在2组中间差异具有显著性(P<0.05)外,其余3项在2组间差异均无统计学意义(P>0.05);多因素logistic回归分析表明,Fn和Fg是ACS的重要危险因子。结论:血浆Fn和Fg水平可能与不稳定的粥样硬化斑块破裂密切相关,参与了血栓形成的病理过程,对预测及早期诊断ACS具有一定的临床价值;血浆Fg水平可作为反映冠状动脉病变狭窄程度的重要指标,而血浆Fn水平却不能作为反映冠状动脉狭窄程度的指标;血浆Fn和Fg水平是传统危险因素外,ACS的独立危险因素。
Objective: To investigate the correlation between the levels of Fn and Fg in patients with acute coronary syndrome (ACS) and the severity of coronary artery stenosis and its clinical significance. Methods: 88 patients undergoing coronary angiography were selected. There were 47 patients with ACS (ACS group), 18 patients with stable angina pectoris (SAP) and 23 patients with normal coronary angiography (Control group). The peripheral blood plasma Fn levels were measured by enzyme-linked immunosorbent assay (ELISA), and plasma Fg levels by thrombin turbidimetry. According to coronary angiography results, divided into single-vessel disease group, double-vessel disease group and 3 lesions group, and combined with improved Gensini coronary artery disease score standard plasma Fn and Fg levels were compared with the degree of coronary artery disease Sex. Results: The levels of plasma Fn and Fg in ACS group were significantly higher than those in SAP group (P <0.01, P <0.05) and Control group (P <0.01) ). There was no significant difference in the level of plasma Fn between single vessel disease group, double vessel disease group and 3 vessel disease group (all P> 0.05), while plasma Fg level was significantly higher in single coronary artery disease group than in single vessel group Lesion group (P <0.05) and double-vessel lesion group (P <0.01). The linear correlation analysis showed that there was a significant correlation between plasma Fn and Fg level (r = 0.381, P <0.01), plasma Fg level was significantly higher than that of modified Gensini score (r = 0.322, P <0.05) and lgLp (a) (r = 0.349, P <0.01), but negatively correlated with ApoA1 (r = -0.324, P <0.01), while there was no significant correlation between other indexes . The plasma Fn mean of all the subjects was used as the cutoff point to divide into Fn≥290.37mg / L group and Fn <290.37mg / L group. The relationship between smoking history, family history, history of hypertension and diabetes mellitus was analyzed. Results There was no significant difference between the two groups except for the history of diabetes mellitus (P <0.05), and the other three were not statistically significant (P> 0.05). Multivariate logistic regression analysis showed that Fn and Fg were ACS Important risk factors. CONCLUSION: Fn and Fg levels in plasma may be closely related to unstable atherosclerotic plaque rupture. They are involved in the pathological process of thrombosis and have some clinical value in predicting and early diagnosis of ACS. Plasma Fg level can be used as a marker of coronary artery disease But the level of plasma Fn is not an index to reflect the degree of coronary artery stenosis. Plasma Fn and Fg levels are the independent risk factors of ACS besides the traditional risk factors.