Clinical Study Of D-dimer/Fibrinogen Ratio Combined With Hs-CRP In Patients With ACS

BackgroundAcute coronary syndrome(ACS)is a group of clinical syndromes caused by coronary artery blood clots,coronary vasospasm or microvascular embolism and other causes,resulting in coronary blood disorders,resulting in acute or subacute myocardial oxygen supply.Therefore,acute coronary syndrome has the characteristics of acute onset and rapid progress,and it is a critical illness for common coronary heart disease in emergency department.Plasma D-dimer and fibrinogen are the terminal and starting markers in the fibrinolysis and coagulation systems,respectively.From activation of the coagulation mechanism to formation of thrombus and secondary fibrinolysis,this process is also the process of the occurrence and development of thrombotic events in acute coronary syndromes.A large number of evidences suggest that D-dimer is closely related to fibrinogen and coronary heart disease,and its content is significantly increased in patients with acute coronary syndrome.The inflammatory theory of atherosclerosis has been around for a long time.The increase of inflammatory response is a risk factor for patients with recent ACS events.In addition to the application of clinical features to assess the severity of the disease,the determination of inflammatory markers can flurther risk stratification of ACS patients.In recent years,plasma D-dimer/fibrinogen ratio(D/F ratio)has been used as an auxiliary diagnosis of acute pulmonary embolism.Studies on D/F ratios have been reported in areas such as ischemic stroke and deep vein thrombosis.Similarly,in patients with ACS,there are also activations of blood coagulation,thrombosis and secondary fibrinolysis.So there are problems like how the D/F ratio correlates with ACS and what trends are present,which are rarely reported in domestic and foreign research.Therefore,we propose that,as a marker of thrombogenic activity,D/F ratio may have a certain correlation with the ACS disease process,and design this clinical retrospective study to explore the clinical value of D/F ratio combined with inflammatory markers hypersensitive C-reactive protein in patients with ACS.ObjectivesThe aim of this study is to analyze the correlation between D-dimer/fibrinogen(D/F)ratio,hypersensitive C-reactive protein(hs-CRP)and the severity of coronary stenosis and the illness in patients with acute coronary syndrome(ACS),and the correlation with thrombus burden in patients with acute ST-segment elevation myocardial infarction,exploring the clinical application value of D/F ratio combined with hs-CRP.MethodsPart ?.Clinical application value of D/F ratio and hs-CRP in patients with ACSCase data of 443 patients were collected and divided into Non-CAD group,stable angina pectoris group(SAP)and acute coronary syndrome group(ACS).ROC curve analysis was used to compare the area under the curve of D-dimer,fibrinogen,D/F ratio and hs-CRP,and the diagnostic value of each index for ACS was analyzed.Patients in the ACS group were divided into single-vessel disease,double-vessel disease and triple-vessel disease according to the number of lesions.The differences among the three groups were analyzed and compared.The Gensini scores of coronary lesions were calculated for each ACS patient,and the scatter plots of the indicators and Gensini scores were made and correlation analysis was performed.The Gensini scores were divided into high Gensini scores and low Gensini scores by median,and single factor and multivariate logistic regression were used to analyze risk factors for high Gensini scores.Part ?.Clinical research of relationship between D/F ratio and hs-CRP in patients with STEMIThe data of 82 patients with acute ST-segment elevation myocardial infarction were collected.The TIMI thrombosis was performed according to the coronary angiography,and patients were divided into low thrombus load group and high thrombus load group.Univariate and multivariate logistic regression were used to analyze risk factors for high thrombus burden.ResultsPart I.Clinical application value of D/F ratio and hs-CRP in patients with ACSThe overall trend of D-dimer,fibrinogen and hs-CRP was Non-CAD group<SAP group<ACS group,and Non-CAD group= SAP group<ACS group for D/F ratio.Four indicators were associated with coronary artery lesion counts in ACS patients(P<0.05),and D-dimer,D/F ratio and hs-CRP were associated with Gensini score in ACS patients(r=0.185 P=0.006;r=0.20,P=0.002;r=0.14,P=0.029).ROC curve indicated that D/F ratio had the same forecast value for ACS diagnosis ashs-CRP in patients with coronary heart disease(Z<1.96,P>0.05),and the combined value of D/F ratio+hs-CRP was better than hs-CRP and D-dimer in the diagnosis of ACS(Z>1.96,P<0.05).Multivariate logistic regression analysis revealed that D/F ratio and hs-CRP were independent risk factors for high Gensini score in ACS patients(OR=1.136,P=0.045;OR=1.197,P<0.001).Part ?.Relationship between D/F ratio and hs-CRP in patients with STEMICompared with grade 1 thrombus,D-dimer and hs-CRP were higher in patients with grade 4 and grade 5 thrombosis(P<0.05),and D/F ratio was larger in grade 5 thrombus patients(P<0.05).There was no significant difference in the content of fibrinogen in patients with thrombosis at all grades(P>0.05).Compared with the low thrombus burden group,patients with high thrombus load had higher D-dimer,D/F ratio and hs-CRP level(P<0.05),and fibrinogen had no significant difference between the two groups(P<0.05).Univariate logistic regression analysis showed that age,diabetes,smoking,LDL-C,hs-CRP,D-dimer and D/F ratio were risk factors for high thrombus burden in STEMI patients;multivariate logistic regression analysis showed that Diabetes,smoking,and hs-CRP are independent risk factors for high thrombus burden in STEMI patients.Conclusion(1)Compared with the Non-CAD group,the D/F ratio and hs-CRP were significantly increased in the coronary heart disease group,which was related to the stability of coronary heart disease and the severity of coronary artery disease;(2)D/F ratio combined with hs-CRP can improve the diagnostic value of ACS and significant positively correlated with coronary artery lesion count and Gensini score in ACS patients,which is an independent risk factor for high Gensini score.(3)In patients with STEMI,D/F ratio and hs-CRP were associated with coronary thrombosis,and hs-CRP was an independent risk factor for high thrombus burden;(4)D/F ratio combined with hs-CRP is helpful for the evaluation of the condition of ACS patients,and has certain clinical application value.