血浆纤维蛋白原和载脂蛋白AⅠ水平与急性冠脉综合征患者PCI术后近期预后的关系研究

Correlation study among fibrinogen, apolipoprotein AⅠlevel and the short-term prognosis of patients with acute coronary syndrome after PCI

关键词:  急性冠脉综合征  纤维蛋白原  载脂蛋白AⅠ  PCI术后不良心血管事件

Key words:  acute coronary syndrome（ACS）  fibrinogen (FIB)  apolipoprotein AⅠ（ApoAⅠ）  after PCI major adverse cardiac events

摘要:

[目的]通过观察行PCI术的急性冠脉综合征（ACS）患者血浆纤维蛋白原（FIB）及载脂蛋白AⅠ（ApoAⅠ）水平与患者PCI术后30 d内不良心血管事件（MACE）发生率的关系，探讨用FIB及ApoAⅠ水平对ACS患者PCI术后近期预后进行预测的可能性。[方法] 测定121例入院后行PCI术的ACS患者，包括不稳定心绞痛(UA)组（n=53），急性心肌梗死（AMI）组（n=68），和64例除外器质性心脏病确诊为心血管神经症者（对照组）的血浆FIB、ApoAⅠ和ApoB水平。根据FIB水平将所有ACS患者分为：Ⅰ组（n=83）:FIB＜4 g/L,Ⅱ组（n=38）：FIB≥4 g/L；按ApoAⅠ水平将所有ACS患者分为：Ⅲ组（n=78）： ApoAⅠ≥1.0 g/L； Ⅳ组（n=43）: ApoAⅠ＜1.0 g/L。分别比较Ⅰ组和Ⅱ组，Ⅲ组和Ⅳ组患者PCI术后30 d的主要MACE的发生情况，分析影响ACS患者PCI术后近期预后的危险因素。[结果](1) AMI组FIB水平显著高于UA组和对照组（P＜0.01）。AMI组与UA组同对照组比较ApoAⅠ明显降低（P＜0.01），AMI组ApoAⅠ水平低于UA组（P＜0.05）。(2)AMI组与UA组分别同对照组比较，ApoAⅠ/ApoB 的比值差异有非常显著性意义（P＜0.01）。(3)在MACE中，Ⅱ组与Ⅰ组比较，严重心律失常、充血性心力衰竭、心室壁瘤、心源性休克的发生率明显增加（P＜0.05）。Ⅳ组与Ⅲ组比较，充血性心力衰竭发生率上有明显差异（P＜0.05）；Ⅱ组与Ⅰ组比较，Ⅳ组与Ⅲ组比较总事件率差异有非常显著性意义（P＜0.01）。[结论]不同FIB和ApoAⅠ水平是影响ACS患者PCI术后近期预后的主要危险因素。

Abstract:

[Objective]The purpose of this study was to investigate the possibility of the prediction about the short-term prognosis of patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) by fibrinogen (FIB) and apolipoprote AⅠ( ApoAⅠ) so as to provide a theoretical basis for ACS treatment by observing the relationship between FIB and ApoAⅠlevel of the patients with ACS who received PCI and the incidence rate of patients’ major adverse cardiac events (MACE) within 30 days after PCI. [Methods]Measure the FIB, ApoAⅠand ApoB level of121 subjects with ACS who received PCI after admission. According to the serum cardiac markers level, ACS patients were divided into two groups: unstable angina (UA) group (n=53) and acute myocardial infarction （AMI） group (n= 68), comparing them with healthy persons’ (control group) FIB, ApoAⅠ and ApoAⅠ/ApoB ratio. According to FIB level, ACS patients were divided into two groups: GroupⅠ (n=83): FIB＜4 g/L; Group Ⅱ (n=38): FIB ≥ 4 g/L; According to the ApoAⅠ level, they were divide into another two groups: Group Ⅲ(n= 78): ApoAⅠ ≥1.0 g/L; Group Ⅳ (n=43) ApoAⅠ＜1.0 g/L. We compared the occurrence of the patients’ MACE after PCI for 30 days between GroupⅠand Group Ⅱ, and between Group Ⅲ and Group Ⅳ, respectively. We analyzed the risk factors which influence the short-term prognosis of patients with ACS after PCI. [Results](1) AMI group’s FIB level was significantly higher than that of FIB UA group and the control group （P＜0.01）. Comparing UA group, AMI group with the control group, we found ApoAⅠ significantly lower （P＜0.01）, while the AMI group’ s ApoAⅠlevel was lower than that of UA group （P＜0.05）. (2) We made AMI group and UA group compare with control group, finding that ApoAⅠ/ApoB ratio difference between them made significant sense. (3) Concerning some elements of MACE (including severe arrhythmia, congestive heart failure, ventricular aneurysm, cardiac shock, death after PCI), GroupⅡ’s incidence rate was increased more than that of Group Ⅰ, but Group Ⅳ with congestive heart failure element was different with Group Ⅲ’s（P＜0.05）. The total MACE incidence rate difference between GroupⅡ and Group Ⅰ, Group Ⅳ and Group Ⅲ had both significant meanings. （P＜0.01）. [Conclusion]Different FIB and ApoAⅠ level are the major risk factors to influence the short-term prognosis of patients with ACS after PCI.