Wasilewski Jarosław, Osadnik Tadeusz, Poloński Lech
III Katedra i Oddział Kliniczny Kardiologii SlAM, ul. Szpitalna 2, 41-800 Zabrze, Poland.
Kardiol Pol. 2006 Sep;64(9):967-72; discussion 973-4.
In a large group of patients with myocardial infarction, lack of tissue reperfusion following successful recanalisation of the infarct-related epicardial artery is seen. Blood flow in the microcirculation depends not only on structural changes in the microvasculature but also on rheological features of the blood itself.
To investigate the association between baseline fibrinogen concentration and myocardial reperfusion following successful coronary angioplasty.
In 105 patients with acute ST-segment elevation myocardial infarction, baseline fibrinogen concentration was compared between patients with successful tissue reperfusion (n=79) and with no myocardial reperfusion (n=26) measured as the degree of ST-segment normalisation after successful recanalisation of the infarct-related artery.
Baseline fibrinogen concentration was significantly higher in the no-reperfusion group than in the reperfusion group (523+/-198.02 mg/dl vs 395.56+/-144.98 mg/dl, p=0.0004). In the overall study population, fibrinogen level correlated positively with maximum creatine kinase MB fraction concentration (r=0.25, p=0.012) and duration of chest pain (r=0.31, p=0.002). Mean fibrinogen concentration was higher in patients with anterior myocardial infarction than in patients with the infarct-related artery other than the left anterior descending artery. The risk of no-reflow phenomenon assessed in multivariate analysis was higher if duration of chest pain was longer (OR=1.46, CI 95% 1.06-2.16, p=0.001) and baseline fibrinogen concentration higher (OR=1.51, CI 95% 1.011-4.58, p=0.021).
Baseline fibrinogen concentration following successful mechanical recanalisation of the infarct-related coronary artery is an independent risk factor of a lack of myocardial reperfusion and it positively correlates with maximum creatine kinase MB fraction concentration and duration of chest pain. High fibrinogen concentration may affect rheological parameters of the blood and play an important role in the pathomechanism of myocardial no-reperfusion phenomenon following successful mechanical recanalisation of the infarct-related coronary artery.
在一大群心肌梗死患者中，梗死相关的心外膜动脉成功再通后仍存在组织再灌注不足的情况。微循环中的血流不仅取决于微血管的结构变化，还取决于血液本身的流变学特征。
研究成功进行冠状动脉血管成形术后基线纤维蛋白原浓度与心肌再灌注之间的关联。
在105例急性ST段抬高型心肌梗死患者中，比较了梗死相关动脉成功再通后组织再灌注成功的患者（n = 79）和无心肌再灌注的患者（n = 26）的基线纤维蛋白原浓度，心肌再灌注情况通过ST段正常化程度来衡量。
无再灌注组的基线纤维蛋白原浓度显著高于再灌注组（523±198.02mg/dl对395.56±144.98mg/dl，p = 0.0004）。在整个研究人群中，纤维蛋白原水平与肌酸激酶MB同工酶的最大浓度呈正相关（r = 0.25，p = 0.012），与胸痛持续时间呈正相关（r = 0.31，p = 0.002）。前壁心肌梗死患者的平均纤维蛋白原浓度高于梗死相关动脉为左前降支以外其他动脉的患者。多因素分析显示，胸痛持续时间越长（OR = 1.46，95%CI 1.06 - 2.16，p = 0.001）和基线纤维蛋白原浓度越高（OR = 1.51，95%CI 1.011 - 4.58，p = 0.021），无复流现象的风险越高。
梗死相关冠状动脉成功机械再通后的基线纤维蛋白原浓度是心肌再灌注不足的独立危险因素，且与肌酸激酶MB同工酶的最大浓度和胸痛持续时间呈正相关。高纤维蛋白原浓度可能影响血液的流变学参数，并在梗死相关冠状动脉成功机械再通后心肌无再灌注现象的发病机制中起重要作用。
