凝血因子對動脈粥狀硬化及後續中風和死亡之影響

The impact of coagulating factors to atherosclerosis and subsequent stroke and death

溫晨帆(Chen-fan Wen)

指導教授 ： 葉志嶸

中山醫學大學/健康管理學院/公共衛生學系碩士班/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00007

摘要

本研究測量頸動脈狹窄發生前之兩個時間點的凝血因子數據，以及後續中風發生及心血管疾病死亡之追蹤，來了解纖維蛋白原是否和後續頸動脈狹窄以及中風發生或與心血管死亡有關，探討纖維蛋白原及頸動脈狹窄在心血管疾病病程所扮演之角色。

心臟血管疾病之社區長期追蹤研究(CardioVascular Disease risk FACtor Two-township Study, CVDFACTS)，包含新竹縣竹東鎮客家地區和嘉義縣朴子市嘉義地區之居民。本研究分析該研究之第二(1991-1993)、第三(1993-1997)、第四(1997-1999)以及第六(2003-2005)循環之資料。 擷取第二(1991-1993)、三(1993-1997)循環基本人口學及生活習慣變項，心血管疾病史、藥物使用與體能活動，以及體檢相關變項；第四循環(1997-1999)頸動脈超音波量測之頸動脈左、右側總頸動脈(Common carotid artery, CCA) 內膜-中膜厚度，依其厚度區分為2組；第六(2003-2005)循環追蹤個案疾病狀況(高血壓、心臟病、中風、糖尿病與其藥物使用資料)、死因、死亡時間。

纖維蛋白原的濃度，在第二循環及第三循環之資料分析中，皆顯示是頸動脈內中膜厚度的顯著影響因子及後續中風發生之危險因子(HR=1.943，P=0.002)；第二循環之資料分析，纖維蛋白原及頸動脈內中膜厚度與心血管死亡或整體死亡並無顯著相關；第三循環之資料分析，纖維蛋白原不是心血管死亡之顯著危險因子，而頸動脈內中膜厚度為心血管死亡之顯著預測因子(HR=2.812，P=0.037)；同時參與第二及第三循環者，兩次纖維蛋白原維持高濃度者，經頸動脈內中膜厚度對中風之影響亦有顯著相關(HR=2.717，P=0.013)；纖維蛋白原濃度上升者，經頸動脈內中膜厚度對中風之影響有邊際顯著 (HR=1.981，P=0.075)。

纖維蛋白原與頸動脈狹窄發生有關，也對後續中風發生有顯著影響；但纖維蛋白原對心血管疾病死亡並不具預測性。

關鍵字

纖維蛋白原 ； 頸動脈內中膜厚度 ； 中風 ； 心血管疾病死亡

並列摘要

This study aims at study the causal effect of clotting factor, fibrinogen, on the atherosclerotic pathogenesis of indicator, Intima-Media Thickness, and on the subsequence events of stroke and death.

Community cardiovascular diseases long follow-up study (CardioVascular Disease risk FACtor Two-township Study, CVDFACTS), includes residents of Chu-Dong and Pu-Chi in Hakka community in Hsin-Chu and Fukien community in Chia-Yi County. Analytic variables are demographic and lifestyle variables, history of cardiovascular disease, medication, physical activity, and physical examination variables in second (1991-1993) and three (1993-1997) cycle; carotid ultrasound measurements of CCA’s (Common Carotid Artery) Intima-Media Thickness in the fourth cycle (1997-1999); cardiovascular disease (hypertension, heart disease, stroke, diabetes, medication) and mortality (causes of death, time of death) follow-up in the sixth cycle(2003-2005).

Both of the concentration of fibrinogen in the second cycle and the third cycle, are shown to be the significant a risk factor for IMT and subsequent stroke, HR=1.943(P=0.002) and HR=1.459(p=0.077), respectively. Fibrinogen of cycle two and cycle 3 has no effect on mortality. For those participants with complete fibrinogen data in cycle two and cycle three, those who with fibrinogen maintained on the top tertile, considering the adjustment of CCA IMT, are significantly correlated to the stroke incidence (HR = 2.717, P = 0.013); and those who with elevated fibrinogen between cycle two and cycle three, considering the adjustment of CCA IMT, the HR for stroke incidence is 1.981 with marginal significance (P=0.075).

In summary, fibrinogen is significantly correlated to the occurrence of carotid stenosis and subsequent stroke. However, fibrinogen has no effect on the CVD mortality and total mortality.

並列關鍵字

Fibrinogen ； Intima-media thickness ； CIMT ； atherosclerosis ； stroke ； CVD mortality

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