目的：探讨急性心肌梗死（AMI）患者血浆纤维蛋白原（Fg）、D‐二聚体（DD）及抗凝血酶Ⅲ（ATⅢ）水平与颈动脉粥样硬化（CAS）的相关性。方法：选择2012年1月至2014年12月我科收治的147例AMI患者为AMI组和无心肌梗死的患者120例为对照组。根据CAS严重程度， AMI组进一步分为正常组（22例）、轻度组（30例）、中度组（40例）和重度组（55例）。检测比较各组间血浆Fg、DD和ATⅢ水平以及颈动脉内－中膜厚度（IMT）。结果：与对照组比较， AMI组血浆Fg [（3.12±0.87） g／L比（5.01±1.38） g／L]、DD [（317±50）μg／L比（1530±218）μg／L]水平和颈动脉IMT [（0.86±0.41） mm比（1.12±0.29） mm]显著升高，血浆ATⅢ水平[（87±18）％比（76±19）％]显著降低， P均＜0.01。与正常组比较，中度组和重度组血浆Fg、DD水平显著升高，血浆ATⅢ水平显著降低（P＜0.05或＜0.01）。Spearman相关分析显示AMI患者的血浆Fg和DD水平与CAS严重程度呈显著正相关（ r＝0.426，0.535， P均＜0.01）， ATⅢ水平与 CAS严重程度呈显著负相关（ r＝－0.438， P＝0.005）。多因素Logistic回归分析显示血浆 Fg和 DD水平是心肌梗死的独立危险因素（OR＝2.836，2.231，P均＜0.01），血浆ATⅢ水平是心肌梗死的独立保护因素（OR＝0.899，P＝0.014）。结论：血浆Fg和DD水平是心肌梗死的独立危险因素，血浆ATⅢ水平是心肌梗死的独立保护因素。%Objective:To explore the correlation among plasma levels of fibrinogen (Fg) ,D-dimer (DD) and antithrombin III (ATIII ) and carotid atherosclerosis (CAS) in AMI patients .Methods:A total of 147 AMI patients treated in our de‐partment from Jan 2012 to Dec 2014 were enrolled as AMI group ,another 120 patients without myocardial infarction (MI) were treated as control group .According to ACS severity ,AMI group was further divided into normal group (n=22) ,mild group (n=30) ,moderate group (n=40) and severe group (n=55) .Plasma levels of Fg ,DD and ATIII ,and carotid inti‐ma-media thickness (IMT) were measured and compared among all groups .Results:Compared with control group ,there were significant rise in plasma levels of Fg [ (3.12 ± 0.87) g/L vs .(5.01 ± 1.38) g/L] ,DD [ (317 ± 50)μg/L vs .(1530 ± 218)μg/L] and carotid IMT [(0.86 ± 0.41) mm vs .(1.12 ± 0.29) mm] ,and significant reduction in plasma AT Ⅲ level [ (87 ± 18)% vs .(76 ± 19)% ] in AMI group , P<0.01 all. Compared with normal group ,there were significant rise in plasma levels of Fg and DD ,and significant reduction in plasma ATIII level in moderate group and severe group , P<0.05 or <0.01. Spearman correlation analysis indicated that plasma Fg and DD levels were significant positively correlated with CAS severity (r=0.426 ,0.535 ,P<0.01 both) ,ATIII level was significant inversely correlated with CAS severity in AMI patients ,(r= -0.438 ,P=0.005) .Multi-factor Logistic regression analysis indicated that plasma Fg and DD levels were independent risk factors for MI (OR=2.836 ,2.231 , P<0.01 both) ,and plasma ATIII level was independent protective factor for MI (OR=0.899 , P=0.014 ) .Conclusion:Plasma Fg and DD levels are independent risk factors for MI and plasma ATIII level is independent protective factor for MI .
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