纤维蛋白原、血栓弹力图（K值）和血栓弹力图（α角）与老年急性冠脉综合征患者冠状动脉复杂病变的相关性研究

doi:10.3760/cma.j.issn.1007-1245.2022.22.002

国际医药卫生导报 ›› 2022, Vol. 28 ›› Issue (22): 3113-3117.DOI: 10.3760/cma.j.issn.1007-1245.2022.22.002

纤维蛋白原、血栓弹力图（K值）和血栓弹力图（α角）与老年急性冠脉综合征患者冠状动脉复杂病变的相关性研究

杨小云申潇竹赵晓斐谢春辉赵金燕胡广云

连云港市第二人民医院老年医学中心，连云港　222006

收稿日期:2022-06-22 出版日期:2022-11-15 发布日期:2022-11-18
通讯作者: 胡广云，Email：94031860@qq.com
基金资助:
江苏省老年健康科研资助项目（LD2021034）

Correlations between fibrinogen and thromboelastogram (K value, α angle) and complex lesions of coronary artery in the elderly with ACS

Yang Xiaoyun, Shen Xiaozhu, Zhao Xiaofei, Xie Chunhui, Zhao Jinyan, Hu Guangyun

Center of Geriatrics, The Second People's Hospital of Lianyungang City, Lianyungang 222006, China

Received:2022-06-22 Online:2022-11-15 Published:2022-11-18
Contact: Hu Guangyun, Email: 94031860@qq.com
Supported by:
Jiangsu Province Elderly Health Research Funding Project (LD2021034)

摘要/Abstract

摘要： 目的　分析老年急性冠脉综合征（ACS）患者入院时纤维蛋白原（Fib）、血栓弹力图［TEG（K值）、TEG（α角）］与冠状动脉复杂病变是否具有相关性。方法　选取2018年6月至2021年6月于连云港市第二人民医院经冠状动脉造影确诊为ACS的老年患者183例，按冠状动脉病变程度分为复杂病变组（111例）、非复杂病变组（72例），选取同期冠状动脉造影排除冠心病的老年患者60例作为对照组，比较组间Fib、TEG（K值）、TEG（α角）水平差异。统计学方法采用单因素方差分析、Kruskall-Wallis检验、χ²检验、二元logistic回归分析、受试者工作特征曲线（ROC）。结果　老年ACS患者冠状动脉复杂病变组Fib水平高于非复杂病变组及对照组［（4.23±1.05）g/L比（3.84±0.71）g/L、（3.76±0.81）g/L］，差异有统计学意义（F=2.530，P=0.012）；复杂病变组TEG（K值）低于非复杂病变组及对照组［（2.18±0.42）min比（2.32±0.59）min、（2.41±0.74）min］，差异有统计学意义（F=2.130，P=0.036）；二元logistic回归分析结果显示Fib是老年ACS患者冠状动脉复杂病变的危险因素（OR=2.023，P=0.015），TEG（K值）是老年ACS患者冠状动脉复杂病变的保护因素（OR=0.591，P=0.018）；通过ROC分析，Fib联合TEG（K值）预测老年ACS患者冠状动脉复杂病变的曲线下面积为0.756，灵敏度和特异度分别为76.68%和63.52%，最佳截断值分别为4.67 g/L和2.07 min。结论　老年ACS患者入院时Fib和TEG（K值）水平与冠状动脉复杂病变相关，对冠状动脉复杂病变有预测价值，Fib为冠状动脉复杂病变的独立危险因素，而TEG（K值）为冠状动脉复杂病变的保护因素。

关键词: 纤维蛋白原, 血栓弹力图（K值）, 血栓弹力图（α角）, 急性冠脉综合征, 冠状动脉复杂病变

Abstract: Objective　To investigate the correlations between fibrinogen (Fib) and thromboelastogram (TEG) (K value, α angle) and complex coronary artery lesions in elderly patients with acute coronary syndrome (ACS). Methods　A total of 183 elderly patients with ACS confirmed by coronary angiography admitted to The Second People's Hospital of Lianyungang City from June 2018 to June 2021 were enrolled in this study. According to the degree of involved coronary artery lesions, they were divided into a complex lesion group (111 cases) and a uncomplex lesion group (72 cases), and sixty elderly patients without coronary heart disease excluded by coronary angiography during the same period were selected as the control group. The Fib and TEG (K value, α angle) were compared among the three groups. One-way analysis of variance, Kruskall-Wallis test, χ² test, binary logistic regression analysis, and receiver operating characteristic curve (ROC) were used for statistical analysis. Results　The Fib level of the complex lesion group [(4.23±1.05) g/L] was significantly higher than that in the uncomplex lesion group [(3.84±0.71) g/L] and the control group [(3.76±0.81) g/L] (F=2.530, P=0.012). The TEG (K value) of the complex lesion group [(2.18±0.42) min] was significantly lower than that in the uncomplex lesion group [(2.32±0.59) min] and the control group [(2.41±0.74) min] (F=2.130, P=0.036). Binary logistic regression analysis showed that Fib level was a risk factor for complex coronary artery lesions in elderly ACS patients (OR=2.023, P=0.015), and TEG (K value) was a protective factor for complex coronary artery lesions (OR=0.591, P=0.018). ROC analysis indicated that the area under the curve predicted by Fib combined with TEG (K value) for complex coronary artery lesions in elderly ACS patients was 0.756, the sensitivity and specificity were 76.68% and 63.52%, the optimal cut-off values were 4.67 g/L and 2.07 min, respectively. Conclusions　Fib and TEG (K value) at admission are not only associated with, but also show predictive values for complex coronary artery lesions in elderly ACS patients. Fib is a risk factor for complex coronary artery lesions in elderly ACS patients, while TEG (K value) is a protective factor.

Key words: Fibrinogen, Thromboelastogram (K value), Thromboelastogram (α angle), Acute coronary syndrome, Complex coronary artery lesions

杨小云申潇竹赵晓斐谢春辉赵金燕胡广云. 纤维蛋白原、血栓弹力图（K值）和血栓弹力图（α角）与老年急性冠脉综合征患者冠状动脉复杂病变的相关性研究[J]. 国际医药卫生导报, 2022, 28(22): 3113-3117.

Yang Xiaoyun, Shen Xiaozhu, Zhao Xiaofei, Xie Chunhui, Zhao Jinyan, Hu Guangyun. Correlations between fibrinogen and thromboelastogram (K value, α angle) and complex lesions of coronary artery in the elderly with ACS[J]. International Medicine and Health Guidance News, 2022, 28(22): 3113-3117.

参考文献

[1] 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2019概要[J]. 中国循环杂志,2020,35(9):833-854. DOI:10.3969/j.issn.1000-3614.2020.09.001.
[2] Libby P, Pasterkamp G, Crea F, et al. Reassessing the mechanisms of acute coronary syndromes[J].Circ Res,2019, 124(1):150-160. DOI: 10.1161/CIRCRESAHA.118. 311098.
[3] 文贤慧,张军华,桂嵘.不同状态下血栓弹力图与凝血功能、血小板数关系的探讨[J].中国实验血液学杂志,2018,26(06):1793-1799. DOI:0.7534/j.issn.1009-2137.2018. 06.035.
[4] 中国医师协会急诊医师分会,国家卫健委能力建设与继续教育中心急诊学专家委员会,中国医疗保健国际交流促进会急诊急救分会. 急性冠脉综合征急诊快速诊治指南(2019)[J]. 中国急救医学,2019,39(4):301-308. DOI:10.3969/j.issn.1002-1949.2019.04.001.
[5] Buljubasic N, Akkerhuis KM, Cheng JM, et al. Fibrinogen in relation to degree and composition of coronary plaque on intravascular ultrasound in patients undergoing coronary angiography[J]. Coron Artery Dis, 2017,28(1):23-32. DOI: 10.1097/MCA.0000000000000442.
[6] Ząbczyk M, Natorska J, Undas A. Fibrin clot properties in atherosclerotic vascular disease: from pathophysiology to clinical outcomes[J]. J Clin Med, 2021,10(13):2999. DOI: 10.3390/jcm10132999.
[7] Surma S, Banach M. Fibrinogen and atherosclerotic cardiovascular diseases-review of the literature and clinical studies[J]. Int J Mol Sci, 2021,23(1):193. DOI: 10.3390/ijms23010193.
[8] Yang Y, Li G, Zhang R. Correlation analysis of acute coronary syndrome with serum IL-18, MMP-9, hs-CRP, and plasma FIB[J]. Biomed Res Int, 2022,2022: 5984184. DOI: 10.1155/2022/5984184.
[9] Song J, Yu T, Sun Z, et al. Comparison of prognostic significance between serum fibrinogen and Global Registry of Acute Coronary Events score for prognosis of patients with non-ST-elevation acute coronary syndromes undergoing percutaneous coronary intervention[J]. Coron Artery Dis, 2020,31(2):124-129. DOI: 10.1097/MCA.0000000000000789.
[10] Ang L, Behnamfar O, Palakodeti S, et al. Elevated baseline serum fibrinogen: effect on 2-year major adverse cardiovascular events following percutaneous coronary intervention[J]. J Am Heart Assoc, 2017, 6(11):e006580. DOI: 10.1161/JAHA.117.006580.
[11] Mahmud E, Ramsis M, Behnamfar O, et al. Effect of serum fibrinogen, total stent length, and type of acute coronary syndrome on 6-month major adverse cardiovascular events and bleeding after percutaneous coronary intervention[J]. Am J Cardiol, 2016,117(10):1575-1581. DOI: 10.1016/j.amjcard.2016.02.032.
[12] 穆利英,吴昱,孟帅,等. 纤维蛋白原与急性冠脉综合征患者冠状动脉病变严重程度的关系研究[J]. 实用心脑肺血管病杂志,2020,28(2):23-26. DOI:10.3969/j.issn.1008-5971. 2020.02.006.
[13] Peng Y, Xia TL, Li YM, et al. Fibrinogen is related to longterm mortality in Chinese patients with acute coronary syndrome but fafled to enhance the prognostic value of the GRACE score[J]. Oncotarget, 2017, 8(13): 20622-20629. DOI: 10.18632/oncotarget.15094.
[14] 世界华人检验与病理医师协会,中国医师协会检验医师分会心血管检验医学专业委员会.血小板功能检测在急性冠脉综合征患者抗血小板治疗中的应用专家共识[J].中华医学杂志,2018,98(22):1743-1751. DOI:10.3760/cma.j.issn.0376-2491.2018.22.005.
[15] Yan XQ, Zhang C, Shi HY, et al. Platelet-fibrin clot strength measured by thromboelastography could predict hypercoagulability and antiplatelet effects in patients after percutaneous coronary intervention[J]. Ann Palliat Med, 2021,10(3):2448-2457. DOI: 10.21037/apm-20- 1728.
[16] Kanji R, Kubica J, Navarese EP, et al. Endogenous fibrinolysis-relevance to clinical thrombosis risk assessment[J]. Eur J Clin Invest, 2021, 51(4): e13471. DOI: 10.1111/eci.13471.
[17] Zeng X, Fang L, Peng Y, et al. A multicenter reference interval study of thromboelastography in the Chinese adult population[J]. Thromb Res, 2020,195:180-186. DOI: 10.1016/j.thromres.2020.07.019.
[18] 杨渊博,杨建章.血栓弹力图对急性冠状动脉综合征患者的诊断价值[J].血栓与止血学,2021,27(3):365-367.DOI:10.3969/j.issn.1009-6213.2021.03.002.
[19] 孔庆瑞,赵云兰,林萍,等. 急性冠状动脉综合征患者血栓弹力图特征及临床意义研究[J]. 国际心血管病杂志,2019,46(3):179-182. DOI:10.3969/j.issn.1673-6583.2019. 03.012.
[20] Wan H, Fan X, Wu Z, et al. Prevalence and impact of fibrinolytic dysregulation in patients with acute coronary syndromes[J]. Thromb J, 2021,19(1):33. DOI: 10.1186/s12959-021-00288-5.

纤维蛋白原、血栓弹力图（K值）和血栓弹力图（α角）与老年急性冠脉综合征患者冠状动脉复杂病变的相关性研究

Correlations between fibrinogen and thromboelastogram (K value, α angle) and complex lesions of coronary artery in the elderly with ACS

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 2

编辑推荐

Metrics

[1]	胡彩虹刘诚张东桥林伟勇. 血清PTX3、MMP-10与急性冠脉综合征严重程度的相关性研究[J]. 国际医药卫生导报, 2022, 28(18): 2534-2537.
[2]	董文敬, 孙经武, 张宁, 刘振, 石新烨, 刘婧玚. 秋水仙碱在心血管疾病中应用的研究进展[J]. 国际医药卫生导报, 2022, 28(12): 1767-1771.