Kontny F, Dempfle C E, Abildgaard U
Department of Cardiology, Aker University Hospital, Oslo, Norway.
Eur Heart J. 1999 Jun;20(11):808-12. doi: 10.1053/euhj.1998.1454.
A novel sensitive method for analyses of soluble fibrin monomer antigen was used to assess the predictive value of fibrin monomer when estimating mortality after acute myocardial infarction.
Fibrin monomer was measured in plasma samples from 293 patients enrolled in a randomized clinical trial of low molecular weight heparin (dalteparin) in acute myocardial infarction (the FRAMI trial). Samples taken on days 2 and 7 were analysed using the Enzymun-Test FM(R)(Boehringer Mannheim, Germany). Non-survivors had significantly higher fibrin monomer levels relative to survivors (day 2, median (min-max): 1.8 mg. l-1(<0.01-73.1) vs 0.4 mg. l-1(<0. 01-103.5), P<0.0001). Fibrin monomer levels were significantly associated with congestive heart failure (P<0.001), enzymatic infarct size (P<0.0001), dalteparin treatment (P<0.001), and thrombolytic therapy (P=0.016). The relationship between fibrin monomer and mortality remained statistically significant after adjustment for these variables. In logistic regression analyses, fibrin monomer levels, age and congestive heart failure were all independent predictors of fatal outcome.
Increased fibrin monomer level is an independent predictor of mortality in patients with myocardial infarction. It allows further risk stratification when combined with known risk factors such as age and presence of congestive heart failure.
采用一种新型的可溶性纤维蛋白单体抗原分析灵敏方法，评估纤维蛋白单体在急性心肌梗死后估计死亡率时的预测价值。
在一项急性心肌梗死低分子量肝素（达肝素）随机临床试验（FRAMI试验）中，对293例患者的血浆样本进行纤维蛋白单体检测。采用德国勃林格殷格翰公司的Enzymun-Test FM(R)对第2天和第7天采集的样本进行分析。相对于存活者，非存活者的纤维蛋白单体水平显著更高（第2天，中位数（最小值 - 最大值）：1.8 mg·l-1（<0.01 - 73.1）对0.4 mg·l-1（<0.01 - 103.5），P<0.0001）。纤维蛋白单体水平与充血性心力衰竭（P<0.001）、酶学梗死面积（P<0.0001）、达肝素治疗（P<0.001）及溶栓治疗（P = 0.016）显著相关。在对这些变量进行校正后，纤维蛋白单体与死亡率之间的关系仍具有统计学意义。在逻辑回归分析中，纤维蛋白单体水平、年龄和充血性心力衰竭均为死亡结局的独立预测因素。
纤维蛋白单体水平升高是心肌梗死患者死亡率的独立预测因素。与年龄和充血性心力衰竭等已知危险因素相结合时，它可进一步进行风险分层。
