作者：穆利英1 ，吴昱 2 ，孟帅 1 ，杜凤和 3 ，郭彩霞 1

单位：

1.100160 北京市，首都医科大学附属北京天坛医院心脏及大血管中心　；2.100160 北京市，首都医科大学附属北京天坛医院肾内科　；3.100160 北京市，首都医科大学附属北京天坛医院综合科；通信作者：郭彩霞，E-mail：cxgbb@163.com

Units：

1.Heart and Great Vessels Center，Beijing Tiantan Hospital Affiliated to Capital Medical University，Beijing 100160，China；2.Department of Nephrology，Beijing Tiantan Hospital Affiliated to Capital Medical University，Beijing 100160，China；3.Integrated Department，Beijing Tiantan Hospital Affiliated to Capital Medical University，Beijing 100160，China；Corresponding author：GUO Caixia，E-mail：cxgbb@163.com

关键词：

急性冠脉综合征；纤维蛋白原；冠状动脉狭窄；SYNTAX 评分；影响因素分析

Keywords：

Acute coronary syndrome；Fibrinogen；Coronary stenosis；SYNTAX score；Root cause analysis

CLC：

R 542.2

DOI：

DOI：10.3969/j.issn.1008-5971.2020.02.006

Funds：

摘要：

背景　急性冠脉综合征（ACS）患者纤维蛋白原升高与患者预后不良有关，但其对 ACS 患者冠状动脉病变严重程度的影响尚不清楚。目的　探讨纤维蛋白原与 ACS 患者冠状动脉病变严重程度的关系。方法　选取 2019年 1—5 月首都医科大学附属北京天坛医院重症监护病房收治的 ACS 患者 108 例，根据 SYNTAX 评分分为轻度病变组（SYNTAX 评分 <23 分，n=74）和中重度病变组（SYNTAX 评分≥ 23 分，n=34）。比较两组患者一般资料〔包括性别、年龄、体质指数（BMI）、高血压发生情况、糖尿病发生情况、脑血管疾病发生情况、冠心病病史、吸烟史〕、实验室检查指标〔包括脑钠肽（BNP）、总胆固醇、粒细胞 / 淋巴细胞比值、平均血小板体积、纤维蛋白原、同型半胱氨酸、估算的肾小球滤过率〕；纤维蛋白原与 ACS 患者 SYNTAX 评分的相关性分析采用 Pearson 相关分析；ACS 患者冠状动脉病变严重程度的影响因素采用多因素 Logistic 回归分析。结果　（1）两组患者男性比例、年龄、BNP、纤维蛋白原比较，差异有统计学意义（P<0.05）；两组患者 BMI、高血压发生率、糖尿病发生率、脑血管疾病发生率、有冠心病病史及吸烟史者所占比例、总胆固醇、粒细胞 / 淋巴细胞比值、平均血小板体积、同型半胱氨酸、估算的肾小球滤过率比较，差异无统计学意义（P>0.05）。（2）Pearson 相关分析结果显示，纤维蛋白原与 ACS 患者 SYNTAX评分与呈正相关（r=0.348，P<0.05）。（3）多因素 Logistic 回归分析结果显示，年龄〔OR=1.119，95%CI（1.021，1.226）〕、纤维蛋白原〔OR=3.458，95%CI（1.038，11.523）〕是ACS患者冠状动脉病变严重程度的影响因素（P<0.05）。结论　纤维蛋白原与 ACS 患者冠状动脉病变程度呈正相关，是 ACS 患者冠状动脉病变严重程度的独立影响因素。

Abstract：

Background　Fibrinogen significantly elevated and it is correlated with the poor prognosis in patientswith acute coronary syndrome（ACS），however，its impact on severity of coronary lesion is unknown yet. Objective　Toinvestigate the relationship between fibrinogen and severity of coronary artery lesion in patients with ACS. Methods　FromJanuary to May 2019，a total of 108 patients with ACS were selected in the Intensive Care Unit，Beijing Tiantan HospitalAffiliated to Capital Medical University，and they were divided into A group（SYNTAX score<23，n=74）and B group（SYNTAXscore ≥ 23，n=34）according to SYNTAX score. Comparison of general information（including gender，age，BMI，incidence of hypertension，diabetes mellitus and cerebrovascular disease，history of coronary artery disease and smoking）andlaboratory examination results（including BNP，TC，granulocyte to lymphocyte ratio，mean platelet volume，fibrinogen，Hcyand eGFR）was compared between the two groups；Pearson correlation analysis was used to analyze the correlations betweenfibrinogen and SYNTAX score in patients with ACS，moreover multivariate Logistic regression analysis was used to analyze theinfluencing factors of severity of coronary artery lesion in patients with ACS. Results　（1）There was statistically significantdifference in male ratio，age，BNP and fibrinogen between the two groups，respectively（P<0.05），while there was nostatistically significant difference in BMI，incidence of hypertension，diabetes mellitus or cerebrovascular disease，proportionof patients with history of coronary artery disease or smoking，TC，granulocyte to lymphocyte ratio，mean platelet volume oreGFR between the two groups（P>0.05）.（2）Pearson correlation analysis results showed that，fibrinogen was positivelycorrelated with SYNTAX score in patients with ACS（r=0.348，P<0.05）.（3）Multivariate Logistic regression analysis resultsshowed that，age〔OR=1.119，95%CI（1.021，1.226）〕and fibrinogen〔OR=3.458，95%CI（1.038，11.523）〕wereinfluencing factors of severity of coronary artery lesion in patients with ACS（P<0.05）. Conclusion　Fibrinogen is positivelycorrelated with the severity of coronary artery lesion in patients with ACS，an it is one of independent influencing factors of theseverity of coronary artery lesion.

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