冠状动脉病变程度与D-二聚体及大动脉弹性的相关性研究

目的 探讨冠状动脉病变与D-二聚体及大动脉弹性的相关性.方法 对所有入选病例行冠状动脉造影,用Gensini法行冠状动脉病变评分,并根据冠状动脉造影(CAG)结果分为单支病变组、多支病变组与正常对照组.在CAG前后进行双侧颈动脉彩色超声检查,同时测量血压,并检测所有入选病例D-二聚体及纤维蛋白原(Fib)水平.结果 ①多支病变组、单支病变组冠状动脉Gensini评分、收缩压(SBP)、脉压差(PP)、PP指数(PI)、D-二聚体及Fib水平高于对照组,Gensini评分多支病变组(29.25±14.20)分、单支病变组(11.97±7.36)分vs对照组(1.36±1.16)分(均P＜0.01);SBP多支病变组(133.99±21.04)mmHg、单支病变组(129.06±19.64)mmHg vs对照组(114.75±10.83)mmHg(均P＜0.01);PP多支病变组(53.93±17.36)mmHg、单支病变组(54.69±22.75)mmHg vs对照组(35.05±10.53)mmHg(均P＜0.01);PI多支病变组0.39±0.09、单支病变组0.41±0.11 vs对照组0.31±0.07(均P＜0.01);D-二聚体多支病变组(1.91±0.84)mg/L、单支病变组(1.26±0.60)mg/L vs对照组(0.26±0.03)mg/L(均P＜0.01);Fib多支病变组(4.54±0.93)g/L、单支病变组(3.89±0.68)g/L vs对照组(3.13±0.52)g/L(均P＜0.01);颈总动脉平均管壁张力(CWS)水平低于对照组(P＜0.01),多支病变组(30.75±10.51)mmHg、单支病变组(41.13±9.82)mmHg vs对照组(60.02±12.68)mmHg(均P＜0.01).②Gensini评分与PP、PI、D-二聚体、Fib呈正相关,与CWS负相关.③多元逐步回归分析显示Gensini评分与D-二聚体呈正相关,与CWS呈负相关.结论 D-二聚体、CWS与冠状动脉Gensini积分相关,可反映冠状动脉病变程度.

Study on relationship between coronary atherosclerosis and D-dimer,large artery elasticity

Objective To explore relationship between the severity of coronary atherosclerosis and D-dimer,blood pressure.Methods All patients had coronary angiography and then,they were divided into single-vessel group,multi-vessel group and normal control group.Double carotid arteries were examined,and blood pressure,D-dimer and fibrinogen were measured.Results ①Levels of Gensini score,systolic blood pressure（SBP）,pulse pressure（PP）,pressure index（PI）,D-dimer and fibrinogen were significantly higher in coronary heart disease group than those in control group（all P〈0.05）.Gensini score in multi-vessel group（29.25±14.20） scores,single-vessel group（11.97±7.36） scores were higher that in control group（1.36±1.16） scores（all P〈0.01）;SBP in multi-vessel group（133.99±21.04） mmHg,single-vessel group（129.06±19.64） mmHg were higher than that in control group（114.75±10.83） mmHg（all P〈0.01）;PP in multi-vessel group（53.93±17.36） mmHg,single-vessel group（54.69±22.75） mmHg were higher than that in control group（35.05±10.53） mmHg（all P〈0.01）;PI in multi-vessel group 0.39±0.09,single-vessel group 0.41±0.11 were higher than that in control group 0.31±0.07（all P〈0.01）;D-dimer in multi-vessel group（1.91±0.84） mg/L,single-vessel group（1.26±0.60） mg/L were higher than that in control group（0.26±0.03） mg/L（all P〈0.01）;Fib in multi-vessel group（4.54±0.93） g/L,single-vessel group（3.89±0.68） g/L were higher than that in control group（3.13±0.52） g/L（all P〈0.01）.The level of circumferential wall stress（CWS） was lower in multi-vessel group（30.75±10.51） mmHg,single-vessel group（41.13±9.82） mmHg than that in control group（60.02±12.68） mmHg（all P〈0.01）.②Gensini coronary angiography score was positively associated with PP,PI,D-dimer and Fib,and was negatively associated with CWS.③Multivariate stepwise analysis revealed that D-dimer,CWS were significantly associated with coronary angiography score.Conclusion D-dimer and CWS are relative to Genesini score,and can evaluate the severity of coronary atherosclerosis.