纤维蛋白原与冠状动脉临界病变血流储备分数的相关性

Relationship Between Fibrinogen and Fractional Flow Reserve in Coronary Intermediate Lesions

目的探讨血浆纤维蛋白原水平与冠状动脉临界病变血流储备分数（FFR）的相关性及其临床意义。方法入选经冠状动脉造影检查为冠状动脉临界病变（冠状动脉狭窄程度为50%~70%）并行FFR检查的患者,根据冠状动脉FFR测得值分为FFR≥0.8组（23例）和FFR〈0.8组（14例）。入选患者均于入院后检测纤维蛋白原、总胆固醇、甘油三酯、尿酸、肌酐、血糖等指标。采用相关分析和ROC曲线分析纤维蛋白原与FFR的相关性。结果应用偏相关分析控制可能影响纤维蛋白原及冠状动脉血管病变的因素包括年龄、性别、血脂、血糖水平等,结果显示FFR〈0.8组患者血浆纤维蛋白原水平明显高于FFR≥0.8组（3.50±0.72 g/L比2.68±0.63 g/L,P〈0.05）,纤维蛋白原水平与FFR值呈负相关（r=-0.477,P〈0.01）;ROC曲线分析显示,最适宜的截断点为2.692 g/L,应用FFR值=0.8作为判断冠状动脉临界病变有无缺血的敏感度为92.9%,特异度为65.2%。结论血浆纤维蛋白原可用于检测冠状动脉临界病变心肌有无缺血,与冠状动脉临界病变心肌缺血程度相关,可作为预测冠状动脉临界病变心肌有无功能性缺血及支架植入的影响因素。

Aim To study the relationgship and the clinical significance between plasma fibrinogen and fractional flow reserve（FFR） in coronary intermediate lesions.Methods The patients were from Department of Cardiovascular of Affiliated Hospital of Xuzhou Medical College.Their coronary artery lesions were assessed by CAG from February 2013 to November 2015,the degree of coronary artery stenosis ranged from 50% to 70%.According to the FFR,the patients were divided into two groups： the FFR≥0.8 group（n = 23） and the FFR0.8 group（n = 14）.Plasma fibrinogen,total cholesterol,triglyceride,uric acid and blood glucose were detected.After controlling the influencing factors of fibrinogen and coronary artery lesions,the correlation between firinogen and FFR was analyzed by correlation analysis and ROC curve.Results Partial correlation analysis showed that fibrinogen was negatively correlated with FFR（r =-0.477,P 0.01）.The levels of fibrinogen in the FFR0.8 group were higher than those in the FFR≥0.8 group（3.50± 0.72 g/L vs.2.68±0.63 g/L,P0.05）.ROC analysis showed that the best cutoff vlaue was 2.692 g/L with the biggest sum of sensitivity and specificity（0.929 and 0.652,respectively）,when FFR = 0.8 as a boundary.Conclusions Plasma fibrinogen can be used to detect myocardial ischemia in coronary intermediate lesions,it is associated with the degree of myocardial ischemia in coronary intermediate disease and can be used as a predictor of myocardial ischemia and stent implantation in coronary intermediate disease.