血栓形成因子および再発性冠動脈イベント
A J Moss1, R E Goldstein, V J Marder
1Cardiology and Vascular Medicine, Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA.
Circulation
|May 20, 1999
まとめ
D-ダイマーとApoBの値が上昇し,ApoA-Iの値が低下すると,心筋梗塞後の患者の再発性冠動脈事件が予測されます. これらの血液因子は,血栓形成状態と脂質輸送の障害を示し,リスクを高めます.
科学分野:
- 心血管医学 心血管医学
- 血液学 ヘマトロジ
- クリニカル生化学 臨床生化学
背景:
- 血栓症は冠動脈疾患の病原性において中心的なものです.
- 心筋梗塞後の再発の危険因子を特定することは極めて重要です.
研究 の 目的:
- 血栓性および脂質性血液因子と,心筋梗塞後の患者の再発性冠動脈イベントの関連性を調査する.
主な方法:
- 心筋梗塞の2ヶ月後の1,045人の患者の将来的な登録.
- 血静性 (D-ダイマー,フィブリノゲン,因子VII,因子VIIa,フォン・ウィレブランド因子,PAI-1),脂質 (コレステロール,トリグリセリド,HDL,LDL,Lp(a),アポA-I,アポB) およびインスリンレベルを測定する.
- 主要エンドポイントとして冠動脈死亡または非致死性心筋梗塞による平均26ヶ月のフォローアップ;コックス生存モデルを使用.
主要な成果:
- 高濃度のD-ダイマー (HR 2.43) は独立して再発性イベントと関連していました.
- 高レベルのapoB (HR1.82) と低レベルのapoA-I (HR1.84) も独立してリスク増加と関連していました.
- アソシエーションは,臨床的共変数を調整した後に依然として有意であった.
結論:
- D-ダイマーの値上昇は,再発性冠動脈イベントに寄与するプロコアグラント状態を示します.
- 低アポA-Iと高アポBによって示される乱れた脂質輸送は,心臓発作後の患者で独立してリスクを増加させます.
- これらのバイオマーカーは,二次予防戦略に関する貴重な洞察を提供します.
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