急性冠状动脉综合征患者外周血血管性血友病因子水平与冠状动脉病变程度的相关性研究

目的 探讨急性冠状动脉综合征（ACS）患者外周血血管性血友病因子（vWF）水平与冠状动脉病变程度的相关性.方法 选取行冠状动脉造影148例ACS患者为ACS组.按ACS患者冠状动脉造影结果,所示病变累及相关冠状动脉支数分为单支病变组（54例）、双支病变组（51例）及多支病变组（43例）;并根据Gensini积分分为三组：Gensini积分≤20分31例（轻度组）,Gensini积分21～40分47例（中度组）,Gensini积分≥41分70例（重度组）.选取稳定型心绞痛（SA）患者50例为SA组,并选取50例冠状动脉正常者为对照组.检测外周血vWF水平,同时检测血常规、凝血功能、肝肾功能、超敏C反应蛋白（hs-CRP）、血糖、血脂等,并分析外周血vWF水平与冠状动脉病变程度的相关性.结果 ACS组白细胞计数和hs-CRP水平显著高于SA组及对照组,差异有统计学意义（P＜0.05）,但SA组与对照组比较差异无统计学意义（P＞0.05）;三组血小板计数、凝血酶原时间、活化部分凝血酶原时间、空腹血糖、凝血酶时间、餐后2h血糖、三酰甘油、总胆固醇比较差异无统计学意义（P＞0.05）.ACS组外周血vWF水平为（143.25±20.42）％,明显高于SA组和对照组的（102.77±11.84）％,（97.63±10.31）％,差异有统计学意义（P＜0.05）.单支病变组外周血vWF水平为（127.34±9.35）％,双支病变组为（144.81±12.02）％,多支病变组为（159.55土18.62）％,单支病变组、双支病变组、多支病变组、对照组组间比较差异有统计学意义（P＜0.01）;轻度组外周血vWF水平为（124.77土14.31）％,中度组为（132.53±16.38）％,重度组为（155.06±18.53）％,轻度组、中度组、重度组及对照组比较差异有统计学意义（P＜0.01）.ACS患者外周血vWF水平与冠状动脉病变支数和冠状动脉造影Gensini积分呈正相关（r=0.698,0.683,P＜0.01）.结论 ACS患者外周血vWF水平与冠状动脉病变严重程度关系密切,在评价ACS患者病情及指导治疗方面有重要临床意义.

The correlation between plasma von Willebrand factor and the extent of coronary artery lesion in acute coronary syndrome

Objective To investigate the correlation between plasma von Willebrand factor（vWF） and the extent of coronary artery lesion in acute coronary syndrome （ACS）.Methods One hundred and forty eight ACS patients （ACS group） who performed coronary angiography （CAG） were divided into single stenosis group （54 patients）,double stenosis group （51 patients） and multitude stenosis group （43 patients） by the number of stenosis through CAG.They were divided into mild group （Gensini score ≤ 20 points,31 patients）,midrange group （Gensini score 21-40 points,47 patients） and severe group （Gensini score ≥ 41 points,70 patients）.Fifty patients with stable angina pectoris （SA） were randomly selected and classified as SA group,while 50 patients with healthy coronary were randomly selected as control group.Blood sample of 248 patients were collected to detect the level of vWF,and blood routine examination,blood clotting function,liver and renal function,high sensitivity C-reactive protein （hs-CRP）,blood glucose,blood fat were detected.The correlation between vWF and the extent of coronary artery lesion were analyzed.Results The level of white blood cell count （WBC） and hs-CRP in ACS group were significantly higher than those in SA group and control group （P 〈 0.05）.But the level of WBC and hs-CRP between SA group and control group had no significant difference （P 〉 0.05）.The level of blood platelet count,prothrombin time,partial prothrombin time,fasting blood glucose,thrombin time,2 h postprandial glucose,triglyceride,total cholesterol had no significant difference among three groups （P 〉 0.05）.The level of vWF in ACS group was significantly higher than that in SA group and control group [（143.25 ± 20.42）% vs.（102.77 ± 11.84）%,（97.63 ± 10.31）%] （P 〈0.05）.The level of vWF in single stenosis group,double stenosis group and multitude stenosis group was （127.34 ± 9.35）%,（144.81 ± 12.02）%,（159.55 ± 18.62）%,and significantly higher than that in control group （P 〈 0.01）.The level of vWF in mild group,midrange group and severe group was （124.77 ± 14.31）%,（132.53 ± 16.38）%,（155.06 ± 18.53）%,and significantly higher than that in control group （P 〈 0.01）.The level of vWF had significantly positive correlation with the number of stenosis and Gensini score （r =0.698,0.683,P 〈 0.01）.Conclusion The level of vWF in peripheral blood is closely related with the severity of ACS and has important clinical significance in evaluating the condition and guiding therapy in patients with ACS.