纤维蛋白原/白蛋白比值预测冠状动脉慢性完全闭塞病变侧支循环形成及预后的价值

王同; 王丰云; 张倩倩; 王培研; 汤建民

doi:10.16766/j.cnki.issn.1674-4152.002130

纤维蛋白原/白蛋白比值预测冠状动脉慢性完全闭塞病变侧支循环形成及预后的价值

doi: 10.16766/j.cnki.issn.1674-4152.002130

郑州大学第二附属医院心血管内科，河南郑州 450014

基金项目:

河南省科技攻关计划项目 162102310516

详细信息

通讯作者:
汤建民，E-mail：tjmgrx@163.com

中图分类号: R543.31
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- 被引次数: 0
出版历程
- 收稿日期: 2020-12-17
- 网络出版日期: 2022-02-15

Value of fibrinogen-to-albumin ratio in predicting the formation and prognosis of collateral circulation in patients with chronic complete coronary artery occlusion

Department of Cardiology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, China

摘要

摘要: 目的探讨入院纤维蛋白原与白蛋白比值(fibrinogen to albumin ratio，FAR)预测冠状动脉慢性完全闭塞病变(chronic total occlusion，CTO)侧支循环形成及预后的价值。方法选取2017年10月—2019年4月在郑州大学第二附属医院择期行经皮冠状动脉介入治疗(percutaneous coronary intervention，PCI)术且至少1支主要冠状动脉CTO的冠心病患者126例。依据Cohen-Rentrop法将CTO患者分为侧支循环不良组(72例)和良好组(54例)。应用多因素logistic回归筛选评价CTO患者侧支循环形成的影响因素，采用受试者工作特征(receiver operating characteristic，ROC)曲线评价FAR预测CTO患者侧支循环形成的价值，以随访1年内主要不良心血管事件(major adverse cardiovascular events, MACE)发生率评价患者预后。结果侧支循环良好组患者FAR和高敏C反应蛋白水平均低于不良组(均P＜0.001)。多因素logistic回归分析显示，FAR、高敏C反应蛋白与CTO患者侧支循环形成良好呈独立负相关。ROC曲线显示，入院FAR水平预测CTO患者侧支循环形成良好的曲线下面积为0.832(95% CI：0.755~0.893，P＜0.001)，诊断临界值为9.62，敏感度为85.19%, 特异度为77.78%。结论入院FAR水平对CTO患者侧支循环形成良好有一定的预测价值。较低FAR患者侧支循环形成更好，MACE事件发生率低，预后越好。
- 冠状动脉慢性完全闭塞病变 /
- 侧支循环 /
- 纤维蛋白原与白蛋白比值 /
- 预后
Abstract: Objective To explore the value of fibrinogen-to-albumin ratio (FAR) in predicting the formation and prognosis of collateral circulation in patients with chronic total occlusion (CTO). Methods From October 2017 to April 2019, 126 coronary heart disease patients with CTO in an at least one major coronary artery were selected for percutaneous coronary intervention (PCI) in the Second Affiliated Hospital of Zhengzhou University. According to the Cohen-Rentrop method, patients with CTO were divided into two groups: poor collateral circulation group (n=72) and good collateral circulation group (n=54). Multivariate logistic regression screening was used to evaluate the influencing factors of collateral circulation formation in patients with CTO. The receiver operating characteristic (ROC) curve was used to evaluate the value of FAR in predicting collateral circulation formation in CTO patients. The incidence of major adverse cardiovascular events (MACEs) within one year of follow-up was used to evaluate the prognosis of patients. Results The levels of FAR and high-sensitivity C-reactive protein in patients with good collateral circulation were lower than those in patients with poor collateral circulation (P < 0.001). Multivariate logistic regression analysis showed an independent negative correlation between FAR, high-sensitivity C-reactive protein and good collateral circulation in patients with CTO. The ROC curve showed that the area under the curve of admission FAR level to predict the formation of collateral circulation in CTO patients was 0.832 (95% CI: 0.755-0.893, P < 0.001), the diagnostic threshold was 9.62, the sensitivity was 85.19%, and the specificity was 77.78%. Conclusion The level of FAR on admission has a certain predictive value for the formation of collateral circulation in patients with CTO. Patients with lower FAR have better collateral circulation formation, lower incidence of MACEs and better prognosis.
- Chronic total occlusion /
- Collateral circulation /
- Fibrinogen-to-albumin ratio /
- Prognosis

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图 1 FAR、纤维蛋白原、白蛋白预测CTO患者侧支循环形成良好ROC曲线

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图 2 hs-CRP、空腹血糖、吸烟预测CTO患者侧支循环形成良好ROC曲线

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表 1 侧支循环不良组与良好组冠心病患者临床基本资料比较

项目	不良组(n=72)	良好组(n=54)	统计量	P值
年龄(x ±s，岁)	67.3±11.8	62.4±12.6	2.221^a	0.029
男性[例(%)]	42(58.3)	30(55.6)	0.097^b	0.755
高血压[例(%)]	40(55.6)	29(53.7)	0.043^b	0.836
糖尿病[例(%)]	26(36.1)	10(18.5)	4.680^b	0.031
吸烟[例(%)]	38(52.8)	17(31.5)	5.690^b	0.017
糖化血红蛋白[M(P₂₅，P₇₅)，%]	5.6(4.9, 7.5)	5.0(4.8, 7.3)	1 409.500^c	0.008
空腹血糖[M(P₂₅，P₇₅)，mmol/L]	5.3(4.6, 5.8)	4.8(3.8, 6.3)	1 378.500^c	0.005
甘油三酯(x ±s，mmol/L)	1.80±0.45	1.76±0.45	0.519^a	0.605
总胆固醇(x ±s，mmol/L)	4.28±1.14	4.14±0.71	0.833^a	0.407
LDL-C[M(P₂₅，P₇₅)，mmol/L]	1.88(1.71, 2.11)	1.90(1.74, 2.39)	1 695.500^c	0.220
HDL-C(x ±s，mmol/L)	1.45±0.38	1.37±0.26	1.306^a	0.194
hs-CRP(x ±s，g/L)	4.89±2.17	2.75±1.82	5.869^a	＜0.001
纤维蛋白原(x ±s，mg/L)	402.0±37.0	362.5±32.9	6.217^a	＜0.001
白蛋白(x ±s，g/L)	37.0±5.2	43.2±5.3	-6.585^a	0.001
FAR[M(P₂₅，P₇₅)]	11.28(9.96, 12.51)	8.31(7.28, 9.12)	653.500^c	＜0.001
LVEF值(x ±s，%)	49.2±4.9	51.1±5.1	-2.097^a	0.038
NT-proBNP[M(P₂₅，P₇₅)，pg/mL]	238.5(88.3, 1 107.2)	100.3(43.1, 141.1)	1 264.000^c	0.001
CTO病变部位[例(%)]			11.501^b	0.074
左前降支	32(44.4)	24(44.4)
左回旋支	20(27.8)	18(33.3)
右冠状动脉	37(51.4)	15(27.8)
介入开通部位[例(%)]			4.788^b	0.588
左前降支	30(41.7)	23(42.6)
左回旋支	18(25.0)	15(27.8)
右冠状动脉	35(48.6)	15(27.8)
1年内主要不良心血管事件[例(%)]	24(33.3)	9(16.7)	10.519^b	0.044
急性心肌梗死	2(2.8)	0(0.0)
恶性心律失常	0(0.0)	1(1.9)
心力衰竭	8(11.1)	4(7.4)
复发心绞痛	11(15.3)	3(5.6)
心源性死亡	3(4.2)	1(1.9)
院前用药[例(%)]
阿司匹林+氯吡格雷/替格瑞洛	65(90.3)	49(90.7)	0.008^b	0.930
β受体阻断剂	43(59.7)	41(75.9)	3.646^b	0.056
ACEI/ARB	30(41.7)	23(42.6)	0.011^b	0.917
钙离子通道阻滞剂	30(41.7)	15(27.8)	2.593^b	0.107
他汀类药物	56(77.8)	42(77.8)	0.001^b	1.000
注：^a为t值，^b为χ²值，^c为U值。

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表 2 CCC形成的影响因素多因素logistic回归分析变量赋值表

变量	赋值
CCC形成良好	是=0，否=1
糖尿病	是=0，否=1
吸烟	是=0，否=1
FAR	以实际值赋值
纤维蛋白原(mg/L)	以实际值赋值
白蛋白(g/L)	以实际值赋值
hs-CRP(g/L)	以实际值赋值
EVEF值(%)	以实际值赋值
NT-proBNP(pg/mL)	以实际值赋值
年龄(岁)	以实际值赋值
糖化血红蛋白(%)	以实际值赋值
空腹血糖(mmol/L)	以实际值赋值

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表 3 CCC形成的影响因素多因素logistic回归分析

变量	β	SE	Wald χ²	P值	OR值(95% CI)
FAR	-0.676	0.171	15.691	＜0.001	0.509(0.364~0.711)
NT-proBNP	＜0.001	＜0.001	3.561	0.059	1.000(1.000~1.001)
hs-CRP	-0.473	0.174	7.381	0.007	0.623(0.443~0.876)
EVEF值	-0.110	0.069	2.530	0.112	0.895(0.782~1.026)
年龄	-0.027	0.020	1.698	0.193	0.974(0.936~1.014)
纤维蛋白原	-0.022	0.007	9.269	0.002	0.978(0.964~0.992)
白蛋白	0.141	0.043	10.773	0.001	1.151(1.058~1.252)
糖化血红蛋白	0.109	0.141	0.603	0.438	1.116(0.846~1.471)
空腹血糖	-0.518	0.244	4.499	0.034	0.595(0.369~0.961)
糖尿病	-0.751	0.440	2.917	0.088	0.472(0.199~1.117)
吸烟	-0.762	0.386	3.901	0.048	0.467(0.219~0.994)

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