摘要目的 探讨血浆纤维蛋白原(fibrinogen,FIB)水平对急性冠脉综合征(acute coronary syndrome,ACS)经皮冠状动脉介入(percutaneous coronary intervention,PCI)术患者预后的预测价值.方法 本研究属于前瞻性研究.选取在2009年6月至2010年12月间郑州大学第一附属医院心内科成功行PCI术的ACS患者1094例,记录患者入院后24h内空腹FIB及其他基本临床资料.于2012年8月至2012年11月行电话或门诊随访,记录终点事件的发生情况.一级终点事件为全因死亡,二级终点事件包括再次PCI,再发心肌梗死,行冠状动脉搭桥术,因心绞痛、心衰、脑卒中再入院.依据FIB四分位数将患者分为四组.G1:PB (FIB) ＜2.95g/L,G2:2.95 g/L≤PB (FIB) ＜3.39 g/L,G3:3.39 g/L≤PB (FIB) ＜4.01 g/L,G4:PB (FIB) ≥4.01 g/L.应用单因素分析和多因素Logistic回归分析探索PCI术预后的相关因素,Kaplan-Meier生存曲线比较不同FIB水平患者生存率的差异.以P＜0.05为差异具有统计学意义.结果 (1)成功随访990例(随访率90.5％),随访时间为(29.3±4.7)个月.170例发生终点事件(17.2％),死亡27例(2.7％);(2)G1、G2、G3、G4组不良事件的发生率呈逐渐升高趋势(12.2％,14.9％,20.2％,22.8％,x2=11.937,P=0.008).(3)多因素Logistic逐步回归分析显示,G3和G4组终点事件的发生率分别是G1组的1.611(OR=1.611,95％CI1.075 ～2.414,P=0.021)和1.616倍(OR=1.616,95％ CI1.130 ～ 2.311,P=0.009).(4) Kaplan-Meier生存曲线分析显示:4组患者未发生终点不良事件的累积生存率差异具有统计学意义(P=0.02).结论 FIB水平可作为ACS患者PCI术后出现不良事件的预测因子,寻找降低血浆FIB水平的方法可能改善ACS的预后.

abstractsObjective To investigate the prognostic value of plasma fibrinogen (FIB) level in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).Methods A total of 1094 patients treated with PCI in Cardiology Department of the first Affiliated Hospital of Zhengzhou University,were enrolled in the prospective study from June 2009 through December 2010.In the first 24 hours after admission,patients 'fasting plasma FIB and other relevant clinical data were collected.The patients were followed by calling or in the Out-Patient Department from August,2012 to November,2012.The primary end-point events of PCI were all-cause mortality.The secondary end-point events of PCI included acute myocardial infarction,coronary artery bypass grafting or readmission for angina pectoris,heart failure or stroke.The patients were divided into four groups according to their plasma FIB level:group 1 (PB (FIB) ＜2.95 g/L); group2 (2.95 g/L≤PB (FIB) ＜3.39 g/L); group 3 (3.39 g/L≤PB (FIB) ＜4.01 g/L); and group 4 (PB (FIB) ≥4.01 g/L).The univariate and multivariate logistic regression analyse were used to explore factors associated with the prognosis.The survival rate was estimated by Kaplan-Meier survival curve.P ＜ 0.05 was considered as statistically significant difference.Results (1) Nine hundred ninety patients (90.5％) were eventually followed-up.The mean followed-up time was (29.3 ± 4.7) months.One hundred seventy (17.2％) patients had adverse events occurred and 27 patients (2.7％) died.(2) The incidences of total end point events were significantly increased with the increasing plasma FIB level in the four groups (12.2％,14.9％,20.2％,22.8％,x2 =11.937,P =0.008).(3) Multiple regression logistic analysis showed the incidences of total end point events in group 3 were increased by1.611 times (OR =1.611,95％CI:1.075-2.414,P=0.021),and 1.616 times in group 4,compared with group1.(4) Kaplan-Meier survival curve analysis showed there were significant differences in cumulative survival rates without adverse events among the four groups (P =0.02).Conclusions The levels of plasma fasting FIB could be considered as a predictor of adverse events.The way of decreasing FIB levels in patients with ACS after PCI may be an effective approach to the improvement of outcome of patients.