Heinrich J, Assmann G
Institute of Clinical Chemistry and Laboratory Medicine, University of Münster, Germany.
J Cardiovasc Risk. 1995 Jun;2(3):197-205.
Ischaemic heart disease and stroke are the major causes of death in the Western world. Established risk factors such as smoking, hypertension and hypercholesterolaemia explain only some of these events. Most myocardial infarctions and cardiac deaths are precipitated by acute occluding coronary thrombi, and it has been known for some time that thrombosis participates in atherogenesis. For these reasons, haemostatic variables have been included in studies of cardiovascular risk. The plasma fibrinogen level is associated with both the severity and the extent of coronary, cerebral and peripheral atherosclerosis. In prospective studies, fibrinogen was found to be an independent predictor of myocardial infarction in both sexes and of stroke in men. The plasma fibrinogen level thus provides information on risk over and above that supplied by established risk factors. Fibrinogen may play a part in atherothrombosis via several mechanisms: (1) by promoting atherosclerosis, (2) as an essential component of platelet aggregation, (3) because the amount of fibrin deposited and the size of the clot are directly related to the plasma fibrinogen level and (4) because fibrinogen increases plasma viscosity. Nevertheless, it is not yet possible to determine whether high fibrinogen levels are a cause or a consequence of cardiovascular disease because no drugs that selectively lower plasma fibrinogen levels are available. In addition, further standardization of measurements is needed before routinely including plasma fibrinogen in cardiovascular risk scores.
缺血性心脏病和中风是西方世界的主要死因。吸烟、高血压和高胆固醇血症等既定风险因素只能解释其中部分发病情况。大多数心肌梗死和心脏死亡是由急性冠状动脉血栓闭塞引发的，而且人们早就知道血栓形成参与动脉粥样硬化的发展过程。基于这些原因，止血变量已被纳入心血管疾病风险研究之中。血浆纤维蛋白原水平与冠状动脉、脑动脉及外周动脉粥样硬化的严重程度和范围均相关。在前瞻性研究中，纤维蛋白原被发现是男女心肌梗死以及男性中风的独立预测指标。因此，血浆纤维蛋白原水平所提供的风险信息超出了既定风险因素所提供的信息。纤维蛋白原可能通过多种机制参与动脉粥样硬化血栓形成过程：（1）通过促进动脉粥样硬化；（2）作为血小板聚集的重要成分；（3）因为沉积的纤维蛋白量和血凝块大小与血浆纤维蛋白原水平直接相关；（4）因为纤维蛋白原会增加血浆粘度。然而，由于尚无选择性降低血浆纤维蛋白原水平的药物，目前尚无法确定高纤维蛋白原水平是心血管疾病的病因还是后果。此外，在将血浆纤维蛋白原常规纳入心血管疾病风险评分之前，还需要进一步规范测量方法。
