人群血清高敏C反应蛋白、血浆纤维蛋白原浓度与心电图ST-T改变的相关性分析

A population-based study on the relationship of serum high-sensitivity C-reactive protein, plasma fibrinogen and ST-T abnormalities on electrocardiogram

目的分析人群血清高敏C反应蛋白（high-sensitivity C-reactive protein,hs-CRP）、血浆纤维蛋白原浓度、心电图ST-T改变、ROSE问卷心绞痛、代谢综合征的相互关系。方法采用整群抽样方法,选取2003年顺德桂洲镇马岗村和番禺大石镇35~59岁村民1 100例进行横断面研究。对人群进行病史、冠状动脉粥样硬化性心脏病（冠心病）ROSE问卷、身高、体质量、腰围、血压、血脂、hs-CRP、纤维蛋白原、心电图检测。对样本按hs-CRP、纤维蛋白原浓度高低、心电图ST-T改变的程度作分层分析。结果资料完整、纳入分析的实际样本数为1 093例。代谢综合征患病率为17.4%。人群纤维蛋白原浓度为（3.88±1.84）g/L,高纤维蛋白原浓度者占16.65%,其中,ROSE问卷心绞痛组最高（4.33±1.28）g/L,其余依次为心电图ST-T异常组（4.26±1.63）g/L、代谢综合征组（4.18±1.35）g/L,心电图无ST-T改变组最低（3.78±1.75）g/L;心电图无ST-T改变组与其他各组比较,差异有统计学意义（P〈0.05）。人群hs-CRP浓度为（3.46±1.14）mg/L,其中代谢综合征组最高（4.72±0.38）mg/L,其余依次为ROSE问卷心绞痛组（4.63±0.47）mg/L、心电图ST-T异常组（4.38±0.72）mg/L,心电图无ST-T改变组最低（3.21±0.89）mg/L;心电图无ST-T改变组与其他各组比较,差异有统计学意义（P〈0.05）。心电图异常组、ROSE问卷心绞痛组、代谢综合征组与它们各自的正常组相比,血清hs-CRP和纤维蛋白原浓度较高,差异有统计学意义（P〈0.05）。心电图ST-T改变的总发生率为21.5%,心电图ST-T轻度改变的发生率为12.5%,心电图ST-T明显改变的发生率为9.0%。ROSE问卷心绞痛的检出率为15.2%,其中,心电图ST-T异常组的ROSE问卷心绞痛检出率为47.7%,显著高于心电图ST-T正常组,差异有统计学意义（P〈0.05）。心电图异常组中,心电图异常越严重者,其血清促炎因子浓度越高。血清促炎因子浓度增高与心电图ST-T段异常存在明显的正相关关系。结论血促炎因子在代谢综合征和Rose问卷心绞痛中扮演重要角色。血促炎因子浓度升高可作为心血管疾病的预测手段;hs-CRP和纤维蛋白原浓度检测结合Rose问卷及心电图ST-T改变,更有助于冠心病高危人群的筛选。

Objectives To assess the associations among concentrations of inflammatory factors [serum high-sensitivity C-reactive protein（hs-CRP） and plasma fibrinogen ], ST-T abnormalities on electrocardiogram（ECG）, ROSE questionnaire angina pectoris and metabolic syndrome in a rural population. Methods Anthropometric and biochemical measurements were investigated in a cross-sectional study, where 1 100 subjects were cluster sampled from 3 000 adults aged 35-59 years in Guizhou Community, Shunde and Dashi Community, Panyu of Guangdong Province in2003. Demographic information, personal and family histories of diseases and ROSE questionnaire were collected.Physical examination and laboratory tests including hs-CRP, fibrinogen and serum lipids were done. Subjects underwent examination on resting 12-lead ECG. ECG tracings were coded with Minnesota Code and classified as ST-T abnormalities ECG or normal ST-T ECG. ST-T abnormalities ECGs were further classified as marked ST-T abnormalities ECG（codes 4-1, 4-2, 5-1 and 5-2） and mild ST-T abnormalities ECG（codes 4-3, 4-4, 5-3 and 5-4）. Results A total number of 1 093 subjects（521 men and 572 women） were finally included in this analysis. The prevalence of metabolic syndrome was 17.4%. The average fibrinogen concentration was（3.88 ±1.84） g / L. The prevalence of high fibrinogen concentrations was 16.65%. ROSE questionnaire angina pectoris group had the highest fibrinogen concentration of（4.33±1.28） g / L, followed by ST-T abnormalities ECG group of（4.26±1.63） g / L and metabolic syndrome group of（ 4. 18 ±1. 35） g / L. They had significantly higher fibrinogen concentrations than normal ST- T ECG group [（ 3. 78 ±1. 75） g / L, P〈0.05 ]. The average hs-CRP concentration was（3.46 ±1.14） mg / L. Metabolic syndrome group had the highest hs-CRP concentration of（4.72 ±0.38） mg / L, followed by ROSE questionnaire angina pectoris group of（4.63 ±0.47 mg / L） and ST-T abnormalities ECG group of（4.38 ±0.72）mg / L. They had significantly higher hs-CRP concentrations than normal ST-T ECG group [（3.21 ±0.89） mg / L, P〈0.05 ]. ST-T abnormalities ECG group, ROSE questionnaire angina pectoris group and metabolic syndrome group had significantly higher hs-CRP and fibrinogen concentrations, compared with their normal groups correspondingly（P〈0.05）. The standardized prevalence of ST-T abnormalities ECG was 21.5%（9.0% in marked ST-T abnormalities ECG group and 12.5% in mild ST-T abnormalities ECG group）. The prevalence of ROSE questionnaire angina pectoris was 15.2%. It was significantly higher in ST-T abnormalities ECG group（47.7%） than in normal ST-T ECG group（P〈0.05）. It was also found that the severer ST-T abnormalities were, the higher hs-CRP concentration was in ST-T abnormalities ECG group. The elevated concentration of hs-CRP was positively correlated with ST-T abnormalities. Conclusions Disturbance of hemostatic and inflammatory system plays an important role in metabolic syndrome and ROSE questionnaire angina pectoris. Elevated concentrations of serum proinflammatory factors are predictors for cardiovascular diseases. It is a contributor to detecting subjects at high risk of coronary heart disease with hs-CRP and fibrinogen combining ST-T abnormalities on ECG and ROSE questionnaire.