Hyperfibrinogenemia is associated with specific histocytological composition and complications of atherosclerotic carotid plaques in patients affected by transient ischemic attacks
Hyperfibrinogenemia is associated with specific histocytological composition and complications of atherosclerotic carotid plaques in patients affected by transient ischemic attacks
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DOI：
10.1161/01.cir.101.7.744
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发表时间：
2000-02-22
期刊：
影响因子：
37.8
通讯作者：
Spagnoli, LG
中科院分区：
文献类型：
--
作者：
Mauriello, A;Sangiorgi, G;Spagnoli, LG
流行病学研究表明，高纤维蛋白原血症是脑血管动脉粥样硬化的独立危险因素。然而，潜在的机制尚不清楚。我们研究了高纤维蛋白原血症是否会改变动脉粥样硬化斑块的组织学组成，并导致斑块破裂导致颈动脉血栓形成。方法与结果：我们研究了71例颈动脉粥样硬化斑块的组织学组成，这些斑块来自于首次短暂性脑缺血发作后行动脉内膜切除术的患者。根据血浆纤维蛋白原值的位数将患者分为3组。高胆固醇血症、高甘油三酯血症、高血压、糖尿病和吸烟习惯也被评估。在组织学分析中，纤维蛋白原最高分位（bbb407 mg/dL）患者的斑块与低分位（21.7%）（P=0.002）和中分位（29.2%）（P=0.009）患者的斑块相比，血栓发生率高（66.7%）。斑块破裂与高纤维蛋白原水平显著相关（54.2%，P=0.003）。多因素logistic回归显示，高纤维蛋白原血症是帽厚下降（P=0.0005）、巨噬细胞泡沫细胞浸润帽厚（P=0.003）、血栓形成（P=0.003）的独立危险因素。当考虑到其他危险因素时，与其他危险因素相比，高纤维蛋白原血症仍然是颈动脉血栓形成的独立预测因子，比值比为5.83。结论：本研究的结果增加了高纤维蛋白原血症的证据，独立于其他危险因素，与颈动脉粥样硬化斑块的特定组织学组成相关，使其易于破裂和血栓形成。
Background-Epidemiological studies have demonstrated that hyperfibrinogenemia is an independent risk factor for cerebrovascular atherosclerosis. However, the underlying mechanisms are poorly understood, We studied whether hyperfibrinogenemia could modify the histological composition of atherosclerotic plaque and precipitate carotid thrombosis resulting from rupture of the plaque.Methods and Results-We studied the histological composition of 71 carotid atherosclerotic plaques from patients who had undergone surgical endarterectomy after a first episode of transient ischemic attack. Patients were divided into 3 groups corresponding to the tertiles of plasma fibrinogen values. Hypercholesterolemia, hypertriglyceridemia, hypertension, diabetes, and smoking habit were also assessed. At the histological analysis, plaques of patients in the highest tertile of fibrinogen (>407 mg/dL) were characterized by a high incidence of thrombosis (66.7% of cases) compared with plaques of subjects in the lower (21.7%) (P=0.002) and middle (29.2%) (P=0.009) tertiles. Plaque rupture was significantly associated with high fibrinogen levels (54.2%, P=0.003). Multivariate logistic regression indicated that hyperfibrinogenemia was an independent risk factor for a decrease in cap thickness (P=0.0005), macrophage foam cell infiltration of the cap (P=0.003), and thrombosis (P=0.003). When the presence of other risk factors was accounted for, hyperfibrinogenemia remained an independent predictor of carotid thrombosis with an odds ratio of 5.83, compared with other risk factors.Conclusions-The results of the present study add to the evidence that hyperfibrinogenemia, independently of other risk factors, is associated with a specific histological composition of carotid atherosclerotic plaques that predisposes them to rupture and thrombosis.