血清抗凝血酶Ⅲ、纤维蛋白原对高危 NSTE-ACS 患者的评估价值

Predictive significance of antithrombin Ⅲ and fibrinogen in patients with non-ST segment-elevation acute coronary syndrome

摘要:

目的 探讨非ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者血清抗凝血酶Ⅲ（AT- Ⅲ）、 纤维蛋白原（FIB）水平对高危患者的评估价值。方法 选取2015 年1 月-2016 年12 月该院根据临床特征和冠 状动脉造影（CAG）确诊为NSTE-ACS 患者280 例为实验组，依据全球急性冠状动脉事件注册（GRACE） 评分将实验组分为低危组47 例（≤ 108 分）、中危组106 例（109 ～ 140 分）、高危组127 例（>140 分）；根据 临床特征和CAG 排除NSTE-ACS 患者40 例作为对照组。分析AT- Ⅲ、FIB 水平在不同组间的差异和与 GRACE 评分的相关性以及GRACE 评分的独立影响因素；受试者工作曲线（ROC）分析AT- Ⅲ、FIB 对高危 NSTE-ACS 的预测价值，Logistic 多因素回归分析高危NSTE-ACS 的预测指标。结果 实验组AT- Ⅲ水平低于 对照组，而FIB 水平高于对照组（P <0.05）；AT- Ⅲ水平与GRACE 评分负相关（P <0.05），FIB 水平与GRACE 评分正相关（P <0.05）；AT- Ⅲ、FIB 是GRACE 评分和高危风险的预测因素（P <0.05）。ROC 分析显示： AT- Ⅲ、FIB ROC 曲线面积为0.797、0.756（P <0.05）；最佳界值分别为85.50 和4.03 ；敏感性分别为69% 和 66% ；特异性分别为91% 和93%。结论 NSTE-ACS 患者血清AT- Ⅲ、FIB 水平与其危险分层密切相关，是评估 危险分层和高危风险的预测因子。

Abstract:

Objective To explore the predictive value of plasma antithrombin Ⅲ and fibrinogen in patients with non-ST segment-elevation acute coronary syndrome (NSTE-ACS). Methods Totally 280 patients diagnosed with NSTE-ACS admitted into the hospital from January 2015 to December 2016 were involved. Forty healthy subjects were regarded as control group. Patients in NSTE-ACS group were further divided into low risk group (score ≤ 108, 47 cases), moderate risk group (109 ≤ score ≤ 140, 106 cases) and high risk group (score > 106, 127 cases) according to GRACE score. Levels of plasma AT- Ⅲ and FIB were measured. Correlation analysis were performed between AT- Ⅲ , FIB level and GRACE score. Multi-factor linear regression was conducted to identify independent predictive factors of GRACE score. ROC curve analysis was utilized to evaluate the significance of AT- Ⅲ and FIB in NSTE-ACS patients. Logistic multivariate regression analysis was performed to find independent predictive factors of NSTE-ACS. Results Compared with the control group, levels of AT-Ⅲ decreased while FIB increased significantly in experimental group (P < 0.05). GRACE score was negatively correlated with AT-Ⅲ (r = -0.494, P < 0.05) while positively correlated with FIB level (r = 0.513, P < 0.05). AT-Ⅲand FIB are independent predictive factors of GRACE score (P < 0.05). The ROC curve analysis showed that the AUC for AT-Ⅲ and FIB were 0.797 and 0.756, respectively (P < 0.05). Cut-off point was 85.50 and 4.03 for AT-Ⅲand FIB, respectively. Sensitivity for AT-Ⅲand FIB were 69%, 66% and the specificity were 91%, 93%, respectively. Conclusions Plasma AT-Ⅲand FIB are both independent predictive factors in evaluating risk stratification for high risk of NSTE-ACS.