高尿酸血症与高纤维蛋白原血症对冠状动脉风险的联合评估价值探讨

The predictive value of serum advanced fibrinogen and uric acid for acute coronary event risk

目的探讨高纤维蛋白原血症和高尿酸血症对急性冠状动脉(冠脉)事件风险的联合评估价值。方法将经冠脉造影确诊有急性冠脉事件(包括不稳定心绞痛和急性心肌梗死)的195例冠心病患者和无急性冠脉事件的69例冠脉造影正常的患者作对照研究,分析纤维蛋白原(FIB)水平和尿酸的差别,以及二者在急性冠脉事件发生风险的联合作用。结果发生急性冠脉事件组患者的纤维蛋白原水平及尿酸高于对照组(FIB分别为4.09g/L±1.36g/L和3.52g/L±1.37g/L,P<0.05;尿酸分别为320μmol/L±91μmol/L和302μmol/L±104μmol/L,P>0.05)。经Logistic回归分析在排除了年龄、性别、高血压、糖尿病等其他因素的影响之后,纤维蛋白原水平与急性冠脉事件的发生存在有意义的回归关系,而尿酸水平未进入回归方程。联合评估发现高纤维蛋白原水平及高尿酸水平的患者发生急性冠脉事件的风险高于单一指标增高者。结论高水平的纤维蛋白原与尿酸有共同促进急性冠脉事件的发生的作用。联合应用纤维蛋白原和尿酸对于全面评价急性冠脉事件风险有着重要意义。

Objective To study the serum advanced fibrinogen （FIB） and uric acid （UA） in predicting acute coronary events risk. Methods 264 patients hospitalized with the suspected diagnosis of coronary heart disease （CHD） were divided into 2 groups according to the results of coronary arteriography： acute coronary event group （ n = 195, 141 males and 54 females, aged 62 ± 12, with laboratory and electrocardiogram proven acute myocardial infarction or unstable angina pectoris and obvious stricture of main coronary artery 〉75% ） and control group （n =69, 31 males and 38 females, aged 65 ±9, without acute coronary event and with normal coronary artery or stricture of branches of coronary artery less than 50% ）. A week before the coronary arteriography fast peripheral venous blood samples were collected. The blood sugar, blood-lipid, FIB, and UA were determined. Results The FIB level of the acute coronary event group was 4.09 g/L ± 1.36 g/L, significantly higher than that of the control group （ 3.52 g/L ± 1.37 g/L, P 〈 0.05）. The UA level of the acute coronary event group was 320 μmol/L ±91 μmol/L, not significantly different from that of the control group （ 302 gmol/L ±104 μmol/L, P 〉 0.05 ）. Excluding the influence of age, sex, blood pressure, blood sugar, etc. multivariate analysis showed that FIB was a significant variable associated with acute coronary events, but UA, not entering the regression equation, was not an independent risk factor. When FIB and UA were both at high levels, acute coronary events risk was much higher than when any single index was at a high level. Conclusion High FIB and UA jointly accelerate the development of atherosclerosis. It may be important to use the index of FIB associated with UA to predict acute coronary risk.