纤维蛋白原/白蛋白比值与冠脉病变严重程度的相关性分析及其临床应用价值

Correlation analysis of fibrinogen/albumin ratio and severity of coronary artery disease and its clinical application value

背景我国心血管疾病患病率逐年上升,其中冠心病标化死亡率仍呈上升态势。因此及时、准确地评估冠脉病变严重程度对降低冠心病死亡率、改善冠心病患者预后具有重要意义。目的探讨冠心病患者纤维蛋白原/白蛋白比值(fibrinogen/albumin ratio,FAR)与冠脉病变严重程度的相关性及其临床应用价值。方法入选2019年1-12月在东南大学附属中大医院心内科行冠脉造影的患者共849例,其中诊断冠心病724例,造影完全正常125例。将冠心病组根据Gensini评分三分位法分为轻度狭窄组242例、中度狭窄组233例和重度狭窄组249例,探讨FAR与冠脉病变严重程度的关系。二元logistic回归分析发生冠心病的独立危险因素。无序多分类logistic回归对冠脉不同狭窄程度的关联因素进行分析。采用受试者工作曲线判断FAR对冠脉中重度病变的诊断价值。结果二元logistic回归显示,在校正其他相关因素后,发现FAR是发生冠心病的独立危险因素(OR=1.504,95%CI:1.266~1.786,P<0.05)。无序多分类logistic回归分析发现,中度狭窄组与轻度狭窄组比较,在校正其他相关因素后,FAR仍是Gensini评分的独立危险因素(OR=1.499,95%CI:1.316~1.708,P<0.05)。重度狭窄组与轻度狭窄组比较,在校正其他危险因素后,FAR仍是Gensini评分的独立危险因素(OR=2.019,95%CI:1.756~2.321,P<0.05)。FAR界值为9.62%时诊断冠心病患者冠脉中重度病变的曲线下面积为0.737(95%CI:0.703~0.769),敏感度为63.7%,特异性为72.7%。结论FAR与冠心病患者冠状动脉病变的严重程度密切相关,是冠心病的独立危险因素,对冠状动脉病变严重程度的评估有一定价值。

Background The prevalence of cardiovascular diseases is increasing year by year in China,and the standardized mortality of coronary heart disease is still on the rise.Therefore,timely and accurate assessment of the severity of coronary artery lesions is of great significance to reduce the mortality of coronary heart disease and improve the prognosis of patients with coronary heart disease.Objective To investigate the correlation between fibrinogen/albumin ratio(FAR)and the severity of coronary artery disease and its clinical application value.Methods A total of 849 patients who underwent coronary angiography in the Department of Cardiology,Zhongda Hospital of Southeast University from January to December in 2019 were enrolled.Among them,724 patients were diagnosed with coronary heart disease and 125 patients were completely normal.The coronary heart disease group was divided into mild stenosis group(n=242),moderate stenosis group(n=233)and severe stenosis group(n=249)to investigate the relationship between FAR and the severity of coronary artery disease.Binary logistic regression analysis was applied to analyze the independent risk factors for coronary heart disease.Disordered multi-class logistic regression analysis was used to analyze the influencing factors of different coronary stenosis degrees.The receiver operating curve(ROC)was used to determine the diagnostic value of FAR for moderate to severe coronary lesions.Results Binary Logistic regression showed that after adjusting for other related factors,FAR was an independent risk factor for coronary heart disease(OR=1.504,95%CI:1.266-1.786,P<0.05).Disordered multi-class logistic regression analysis found that compared with the mild stenosis group,after adjusting for other related factors,FAR was still an independent risk factor for Gensini scores in the moderate stenosis group(OR=1.499,95%CI:1.316-1.708,P<0.05).Comparing the severe stenosis group with the mild stenosis group,after adjusting for other risk factors,FAR was still an independent risk factor for Gensini scores(OR=2.019,95%CI:1.756-2.321,P<0.05).When the cut-off value of FAR was 9.62%,the area under the curve(AUC)for the diagnosis of moderate and severe coronary artery lesions in patients with coronary heart disease was 0.737(95%CI:0.703-0.769),with the sensitivity of 63.7%and the specificity of 72.7%.Conclusion FAR is closely related to the severity of coronary artery disease in patients with coronary heart disease,which is an independent risk factor of coronary artery disease and has a certain value in the evaluation of the severity of coronary artery disease.