纖維蛋白原與頸動脈狹窄之相關性研究

The Relationship between Fibrinogen and Carotid Stenosis

許薳(Yuan Hsu)

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(2009年)

摘要

前言：心臟疾病和腦血管疾病為台灣近年嚴重之健康問題，心血管疾病之發生主因動脈粥狀硬化，導致動脈狹窄，進而引發中風或心肌梗塞。而纖維蛋白原以證實與動脈粥狀硬化及中風有關，但纖維蛋白原之角色，如獨立危險因子、中介因子、或沈澱因子等，仍須研究來釐清。本研究將對纖維蛋白原與動脈粥狀硬化之關係。
材料與方法：本研究以「竹東及朴子地區心臟血管疾病之社區長期追蹤研究加值型資料庫」之社區居民為資料來源，收集第二及第四循環資料，並排除無完整問卷、體位測量、抽血檢驗、頸動脈超音波資料者，計2000人資料納入研究分析。採用Cohort以及巢式病例對照研究設計，以密度取樣、Propensity score matching(傾向分數配對, PSM)選取對照及配對。分析纖維蛋白原與頸動脈中膜厚度(Carotid intima-media thickness, Carotid IMT)之相關性，其結果呈現勝算比(Odds Ratio, OR)指標及95%信賴區間。
結果：本研究顯示IMT異常者其纖維蛋白原濃度明顯高於IMT正常者。其纖維蛋白原濃度越高得到動脈粥狀硬化的機會也越高。發現纖維蛋白原與其他危險因子也發現交互作用的存在，纖維蛋白原與喝酒習慣之交互作用證明有喝酒習慣且纖維蛋白原較低者比沒喝酒習慣或是喝酒且纖維蛋白原偏高者比較不會有動脈粥狀硬化情形的發生。
結論：證實了確實纖維蛋白原濃度越高得到動脈粥狀硬化之風險也越高，此外也發現纖維蛋白原與喝酒之交互作用，因此，有效的降低纖維蛋白原濃度以及適度的飲酒或許可以成為防範心血管疾病及腦血管病變有效方法之一。

關鍵字

纖維蛋白原 ； 動脈粥狀硬化 ； 頸動脈中膜厚度

並列摘要

Background
Cardiovasuclar and cerebrovascular diseases are serious health problems in Taiwan. Artery stenosis, an indicator of atherosclerosis, causes cardiovascular disease, such as stroke or myocardial infarction.
Fibrinogen is related to atherosclerosis and stroke and plays a role as an independent risk factor. But it is still a debate on its intervening effect and precipitating factors on atherosclerosis. The aims of this study are to explore the relationship between fibrinogen and atherosclerosis.

Materials and Methods
Two thousand participants from the second and the fourth cycles of Cardiovascular Disease Risk Factor Two-township Study (CVDFACTS) were analyzed and incomplete data of questionnaire, anthropometric parameters, biochemical markers, and carotid ultrasound parameters were excluded.
Three study designs, cohort study, nested case-control study, case-control study with propensity score matching(PSM), were used and compared. Odds ratio (OR) and 95% confidence interval were used to test the strength of correlation between fibrinogen and carotid intima-media thickness (Carotid IMT).

Results
Fibrinogen is higher in abnormal IMT than in normal IMT. Fibrinogen is an significant indicator of atherosclerosis. In addition, we find alcohol drinking may modify fibrinogen effect on atherosclerosis; alcohol drinkers with lower fibrinogen level are having lower hazard of atherosclerosis.
.
Conclusions
Subjects with higher fibrinogen have higher hazard of atherosclerosis. Furthermore, alcohol drinking is a significant modifier. Therefore, moderate alcohol drinking in subjects with lower fibrinogen level may prevent coronary heart disease and cerebrovascular disease.

並列關鍵字

fibrinogen ； atherosclerosis ； carotid intima-media thickness

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