急性冠脉综合征患者血清纤维蛋白原、炎症因子检测的临床意义

Clinical significances of serum inflammatory factor and fibrinogen levels in acute coronary syndrome

目的 探讨冠心病患者凝血功能紊乱、炎症因子表达与动脉粥样硬化斑块不稳定性的关系,为冠心病发病机制的研究提供新的思路.方法 选择2007年10月至2008年8月于心内科行冠脉造影或冠脉CT患者195例,入院前均未行调脂治疗,按冠脉造影或冠脉CT结果分为健康对照组45例,稳定型心绞痛（SAP）组41例,急性冠脉综合征（ACS）组109例.分别于入院当时检测血清脂蛋白、纤维蛋白原（FIB）、单核细胞趋化蛋白-1（MCP-1）、高敏C反应蛋白（hs-CBP）水平.结果 冠心病患者的FIB、血清炎症因子MCP-1、hs-CRP、血脂水平明显升高（P〈0.05）,差异有统计学意义,表明患者存在炎症反应、脂代谢和凝血功能紊乱.与SAP组患者相比,ACS患者hs-CRP、FIB水平升高,差异有统计学意义,hs-CBP水平与FIB正相关,表明二者主要与动脉粥样硬化斑块的不稳定性相关.MCP-1与冠脉积分正相关,表明血清MCP-1水平可能反应冠脉病变的严重程度.结论 ACS患者血清hs-CRP、FIB较稳定型冠心病患者明显升高,二者呈相关关系,表明hs-CBP、FIB水平与冠脉粥样斑块的不稳定性相关,炎症反应和凝血异常可能相互促进,共同诱发斑块破裂,引起ACS.MCP-1与冠脉积分正相关,可能反映冠脉病变的严重程度.对ACS患者联合进行上述指标的检测有利于判断病情,尽早治疗,以改善预后.

Objective To investigate serum high-sensitivity C reactive protein （hs-CRP）, monocyte chemoattractant protein-1 （MCP-1） and fibrinogen （FIB） levels in patients with acute coronary syndrome （ACS） and stable angina pectoris （SAP） and their correlations with atheromatous plaque unstability of coronary artery. Methods 195 patients from Oct, 2007 to Aug, 2008 were divided into two groups according to coronary artery angiography（CAG）, 150 cases with CHD and 45 cases with normal coronary angiograms（no-CHD group）,including 109 patients with ACS and 41 patients with SAP. Serum HDL-C, MCP-1 and fibrinogen levels were measured im- mediately after admitting to hospital. Results Serum LDL-C and HDL-C were respectively significantly higher and lower in the CHD groups than in no-CHD groups. In patients with ACS,serum hs-CRP,FIB were significantly higher than patients with SAP. Serum MCP-1 levels were positively correlated with the Gensini score. Conclusion The results indicate that hs-CRP, FIB were positively correlated with the unstability of atheromatous plaque in pa- tients with ACS and that MCP-1 may be a useful marker of the severity of coronary atherosclerosis in patients with CHD.