Associations of plasma fibrinogen assays, C-reactive protein and interleukin-6 with previous myocardial infarction
Associations of plasma fibrinogen assays, C-reactive protein and interleukin-6 with previous myocardial infarction
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DOI：
10.1046/j.1538-7836.2003.00467.x
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发表时间：
2003-11-01
影响因子：
10.4
通讯作者：
Nieuwenhuizen, W
中科院分区：
文献类型：
--
作者：
Lowe, GDO;Woodward, M;Nieuwenhuizen, W
背景资料：血浆纤维蛋白原与心肌梗死（MI）的相关性（与C-反应蛋白CRP相似）可能是亚临床炎症的标志物，由细胞因子如白细胞介素-6（IL-6）介导。通常进行的纤维蛋白原测定之间存在公认的差异。已提出将氯代纤维蛋白原与完整纤维蛋白原的比率增加（通过最近开发的免疫测定法测量）作为高功能纤维蛋白原的量度，并且在急性MI中升高。目的：在既往MI的病例对照研究中，比较完整纤维蛋白原和4种常规纤维蛋白原测定（2种von Clauss测定; 1种凝血酶原时间衍生测定; 1种免疫荧光测定）的相关性。患者/方法：病例（n = 399）在事件发生后3-9个月招募; 413名对照来自病例对照研究当地人群，年龄和性别匹配。在50%的受试者中测量到完整的纤维蛋白原。结果如下：所有常规纤维蛋白原测定均显示病例组与对照组之间存在高度相关性（r = 0.82-0.93），且平均水平显著升高（P < 0.0001）。这四种常规检测仅与完整纤维蛋白原中度相关（r = 0.45-0.62），而完整纤维蛋白原仅显示病例组与对照组相比小幅、非显著性增加。因此，病例组与对照组相比，四种常规测定中的每一种与完整纤维蛋白原测定的比率显著更高（P < 0.0003）。每种纤维蛋白原测定与CRP和IL-6的血浆水平相关（与对照组相比，病例组的CRP和IL-6水平也升高）。在进一步调整C-反应蛋白和白细胞介素-6后，病例组与对照组相比，每个常规纤维蛋白原测定均显著升高。结论：这些数据提供了MI幸存者获得性高功能血浆纤维蛋白原增加的证据，这与炎症反应标志物无关。这些结果的原因和意义仍有待于在前瞻性研究中确定。
Background: The association of plasma fibrinogen with myocardial infarction (MI) may (like that of C-reactive protein, CRP) be a marker of subclinical inflammation, mediated by cytokines such as interleukin-6 (IL-6). There are well-recognized discrepancies between commonly performed fibrinogen assays. Increased ratio of clottable fibrinogen to intact fibrinogen (measured by a recently developed immunoassay) has been proposed as a measure of hyperfunctional fibrinogen, and is elevated in acute MI. Objective: To compare the associations of intact fibrinogen and four routine fibrinogen assays (two von Clauss assays; one prothrombin-time derived; and one immunonephelometric) in a case-control study of previous MI. Patients/methods: Cases (n = 399) were recruited 3-9 months after their event; 413 controls were age- and sex-matched from the case-control study local population. Intact fibrinogen was measured in 50% of subjects. Results: All routine fibrinogen assays showed high intercorrelations (r = 0.82-0.93) and significant (P < 0.0001) increased mean levels in cases vs. controls. These four routine assays correlated only moderately with intact fibrinogen (r = 0.45-0.62), while intact fibrinogen showed only a small, nonsignificant increase in cases vs. controls. Consequently, the ratio of each of the four routine assays to the intact fibrinogen assay was significantly higher (P < 0.0003) in cases vs. controls. Each fibrinogen assay correlated with plasma levels of CRP and IL-6 (which were also elevated in cases vs. controls). Each routine fibrinogen assay remained significantly elevated in cases vs. controls after further adjustment for C-reactive protein and interleukin-6. Conclusions: These data provide evidence for acquired, increased hyperfunctional plasma fibrinogen in MI survivors, which is not associated with markers of inflammatory reactions. The causes and significance of these results remain to be established in prospective studies.