血浆D-二聚体/纤维蛋白原比值及超敏C反应蛋白在急性冠脉综合征中的临床价值

The clinical value of D-dimer/fibrinogen ratio and hypersensitive C-reactive protein in patients with acute coronary syndromes

目的分析急性冠脉综合征(ACS)患者血浆D-二聚体/纤维蛋白原比值(D/F比值)和超敏C反应蛋白(hs-CRP)水平与ACS患者冠脉狭窄程度及病情严重程度的相关性,探讨D/F比值的临床价值。方法收集2014年1月-2017年12月在南方医科大学南方医院心血管内科行冠状动脉造影检查的443例患者的病例资料,将其分为正常组、稳定型心绞痛(SAP)组和ACS组,进一步将ACS组按冠脉病变支数分为单支病变组、双支病变组和三支病变组,按Gensini积分中位数分为高Gensini积分组和低Gensini积分组。分析各组D-二聚体、纤维蛋白原、D/F比值及hs-CRP等4项指标与ACS的相关性,以及对ACS诊断预测及病变严重程度评估的价值。结果 D-二聚体、纤维蛋白原及hs-CRP在各组中总体趋势为正常组<SAP组<ACS组,而D/F比值总体趋势为正常组=SAP组<ACS组;4项指标均与ACS患者冠脉病变支数相关(P<0.05),D-二聚体、D/F比值及hs-CRP等3项指标与ACS患者Gensini积分相关(r=0.18,P=0.006;r=0.20,P=0.002;r=0.14,P=0.029),在冠心病患者中D/F比值对ACS的诊断预测价值与hs-CRP相当(Z=0.449<1.96,P>0.05);多因素logisitic回归分析结果显示,D/F比值和hs-CRP是ACS患者高Gensini积分的独立危险因素(OR=1.136,P=0.045;OR=1.197,P<0.001)。结论 D/F比值、hs-CRP与ACS患者冠脉病变的严重程度相关,是ACS患者高Gensini积分的独立危险因素。

Objective To analyze the correlation between D-dimer/fibrinogen(D/F) ratio, hypersensitive C-reactive protein(hs-CRP) level and the severity of coronary stenosis and illness in patients with acute coronary syndrome(ACS), and explore the clinical application value of D/F ratio. Methods The case data of 443 patients undergone coronary angiography in the Department of Cardiology, Nanfang Hospital, Southern Medical University during Jan. 2014 to Dec. 2017 were collected, and then the patients were divided into normal group, stable angina pectoris(SAP) group and acute coronary syndrome(ACS) group. The ACS group was divided into single-vessel disease group, double-vessel disease group and triple-vessel disease group according to the number of coronary lesions and into high Gensini score group and low Gensini score group according to the median of Gensini score. The correlations of D-dimer, fibrinogen, D/F ratio and hs-CRP with ACS were compared respectively, and then analyzing the predictive value for diagnosis of ACS and evaluation of lesion severity. Results The overall trend of D-dimer, fibrinogen and hsCRP was normal group <SAP group <ACS group, and normal group =SAP group <ACS group for D/F ratio. Four indicators were associated with coronary artery lesion counts in ACS patients(P<0.05), and D-dimer, D/F ratio and hs-CRP were associated with Gensini score in ACS patients(r=0.18, P=0.006;r=0.20, P=0.002;r=0.14, P=0.029). ROC curve indicated that D/F ratio had the same predictive value for ACS diagnosis as hs-CRP in patients with coronary heart disease(Z=0.449<1.96, P>0.05). Multivariate logistic regression analysis revealed that D/F ratio and hs-CRP were independent risk factors for high Gensini score in ACS patients(OR=1.136, P=0.045;OR=1.197, P<0.001). Conclusion D/F ratio and hs-CRP were significantly associated to the severity of coronary lesion, and were the independent risk factors for high Gensini score in patients with ACS.