Toss H, Lindahl B, Siegbahn A, Wallentin L
Department of Cardiology, University Hospital, Uppsala, Sweden.
Circulation. 1997 Dec 16;96(12):4204-10. doi: 10.1161/01.cir.96.12.4204.
The prognostic influences of fibrinogen and C-reactive protein levels and their relations to myocardial damage in unstable coronary artery syndromes have not been well described.
Fibrinogen and C-reactive protein were determined at inclusion and related to outcome after 5 months in 965 patients with unstable angina or non-Q-wave myocardial infarction randomized to 5 weeks with low-molecular-weight heparin or placebo. The probabilities of death were 1.6%, 4.6%, and 6.9% (P=.005) and the probabilities of death and/or myocardial infarction were 9.3%, 14.2%, and 19.1% (P=.002), respectively, in patients stratified by tertiles of fibrinogen (< 3.38, 3.38 to 3.99, and > or = 4.0 g/L). The probabilities of death were 2.2%, 3.6%, and 7.5% (P=.003) after stratification of patient data by tertiles of C-reactive protein level (< 2, 2 to 10, and > 10 mg/L). In logistic multiple regression analysis, increased fibrinogen levels were independently associated with the incidence of death and/or myocardial infarction (P=.013), and elevated C-reactive protein level was associated with the incidence of death (P=.012). The increased relative risk of subsequent death or myocardial infarction in individuals with an elevated fibrinogen level was consistent in most subgroups evaluated; although significantly so only in patients with signs of myocardial damage.
Increased levels of both fibrinogen and C-reactive protein are associated with a worse outcome in patients with unstable coronary artery disease. The increased risk associated with elevated fibrinogen levels is independent of, and additive to, the prognostic influence of myocardial damage.
在不稳定型冠状动脉综合征中，纤维蛋白原和C反应蛋白水平的预后影响及其与心肌损伤的关系尚未得到充分描述。
对965例不稳定型心绞痛或非Q波心肌梗死患者进行了研究，这些患者被随机分为接受5周低分子量肝素治疗组或安慰剂组。在纳入时测定纤维蛋白原和C反应蛋白水平，并与5个月后的预后相关联。根据纤维蛋白原三分位数（<3.38、3.38至3.99、≥4.0 g/L）分层的患者中，死亡概率分别为1.6%、4.6%和6.9%（P = 0.005），死亡和/或心肌梗死概率分别为9.3%、14.2%和19.1%（P = 0.002）。根据C反应蛋白水平三分位数（<2、2至10、>10 mg/L）对患者数据进行分层后，死亡概率分别为2.2%、3.6%和7.5%（P = 0.003）。在逻辑多元回归分析中，纤维蛋白原水平升高与死亡和/或心肌梗死发生率独立相关（P = 0.013），C反应蛋白水平升高与死亡发生率相关（P = 0.012）。在大多数评估的亚组中，但仅在有心肌损伤迹象的患者中显著，纤维蛋白原水平升高个体随后发生死亡或心肌梗死的相对风险增加是一致存在的。
纤维蛋白原和C反应蛋白水平升高均与不稳定型冠状动脉疾病患者的不良预后相关。纤维蛋白原水平升高相关的风险增加独立于心肌损伤的预后影响，并与之相加。
