C反应蛋白和纤维蛋白原与合并结缔组织病的冠心病患者长期预后的相关性研究

Correlation of C-Reaction Protein and Fibrinogen Level on Long-Term Outcome in Patients with Coronary Heart Disease Combined with Connective Tissue Diseases

目的探讨C反应蛋白(CRP)和纤维蛋白原(Fib)与合并结缔组织病(CTD)的冠心病患者长期预后的相关性,以及对主要不良心血管事件(MACE)的预测价值。方法选择2009年1月至2012年6月在首都医科大学附属北京友谊医院心血管内科接受经皮冠状动脉介入(PCI)治疗的106例合并CTD的冠心病患者为研究对象,按CRP和Fib水平分组,平均随访3年,评估发生MACE的风险。结果 CRP>10 mg/L且Fib>4.0 g/L的患者发生MACE的风险高于CRP≤10 mg/L且Fib≤4.0 g/L的患者(HR=0.260,95%CI 0.092~0.734,P<0.05);CRP>10 mg/L且Fib>4.0 g/L的患者发生心源性死亡事件的风险高于CRP≤10 mg/L且Fib≤4.0 g/L的患者(HR=0.156,95%CI 0.015~1.605,P<0.05)。Fib与CRP呈正相关(r=0.442,P<0.05),但在调整血脂、高血压后,CRP与Fib的相关系数下降(r=0.283,P<0.05)。结论高水平的CRP和Fib与合并CTD的冠心病患者MACE发生率有一定相关性,两者联合检测可增加对合并CTD的冠心病患者MACE的预测价值。

Objective To investigate the correlation of elevated C-reaction protein(CRP)and fibrinogen(Fib)level with long-term prognosis and major adverse cardiac events(MACE)in coronary heart disease patients with connective tissue diseases(CTD).Methods Medical records of 106 coronary heart disease patients combined with CTD who underwent percutaneous coronary intervention(PCI)in Beijing Friendship Hospital,Capital Medical University from Jan.2009 to Jun.2012 were collected.The 106 patients were divided into different groups according to CRP and Fib level.MACEs were assessed during three years of follow-up.Results The risk of MACE events in patients with CRP>10 mg/L and Fib>4.0 g/L was higher than that of CRP≤10 mg/L and Fib≤4.0 g/L(HR=0.260,95%CI 0.092-0.734,P<0.05).Patients with CRP>10 mg/L and Fib>4.0 g/L had a higher risk of cardiac death than CRP≤10 mg/L and Fib≤4.0 g/L(HR=0.156,95%CI 0.015-1.605,P<0.05).Fib was positively correlated with CRP(r=0.442,P<0.05),but the correlation coefficient of CRP and Fib decreased after the adjustment of blood lipid and hypertension(r=0.283,P<0.05).Conclusion High levels of CRP and Fib are independent important predictors of MACEs in coronary heart disease patients combined with CTD.Combined detection of CRP and Fib level can increase the predictive value for cardiac events of coronary heart disease patients combined with CTD.