血管性血友病因子、D-二聚体、纤维蛋白(原)降解产物、纤维蛋白单体与冠状动脉病变程度及预后的相关性研究

Correlation of von Willebrand Factor, D-Dimer, Fibrin(ogen) Degradation Products, and Fibrin Monomer with the Severity and Prognosis of Coronary Artery Disease

摘要: 冠状动脉粥样硬化性心脏病(Coronary Artery Disease, CAD)是全球范围内致死致残的主要病因之一。据世界卫生组织(WHO) 2024年报告，全球每年约有960万人死于冠心病。而包含冠心病在内的心脑血管疾病更是当前威胁人类健康的第一大杀手，据全球疾病负担研究(GBD 2023)数据，全球每年因这类疾病死亡的人数超过1920万，致死率和致残率均高于癌症。动脉粥样硬化斑块破裂后触发血栓形成，是急性冠脉综合征(Acute Coronary Syndrome, ACS)的核心病理机制。在此过程中，凝血系统激活、血小板黏附聚集以及纤溶系统功能紊乱共同决定了血栓的形成、扩展与转归。血管性血友病因子(vWF)、D-二聚体(D-dimer)、纤维蛋白(原)降解产物(FDP)及纤维蛋白单体(FM)作为反映血管内皮功能、凝血酶生成、纤维蛋白形成与降解的关键分子标志物，近年来在CAD的病情评估和预后判断中受到广泛关注。其中vWF主要由血管内皮细胞合成，可介导血小板在血管损伤部位的黏附并稳定凝血因子VIII，能直接反映血管内皮状态；D-二聚体作为纤维蛋白的降解产物，其浓度增加反映体内高凝状态和继发性纤溶亢进，而CAD形成过程中会出现凝血亢进、纤溶功能低下，易导致D-二聚体升高，这也使其成为CAD病情评估的重要指标。本文系统综述上述四种标志物的生物学特性及其与冠状动脉病变严重程度及长期预后的相关性研究进展，探讨单一标志物及联合检测的临床应用价值，并分析现有研究的局限性与未来发展方向。

Abstract: Coronary artery disease (CAD) is one of the leading causes of death and disability worldwide. According to the World Health Organization (WHO) 2024 report, approximately 9.6 million people die from CAD globally each year. Cardiovascular and cerebrovascular diseases, including CAD, represent the foremost threat to human health, with the Global Burden of Disease Study (GBD 2023) reporting over 19.2 million annual deaths worldwide from these conditions, whose mortality and disability rates exceed those of cancer. Thrombus formation triggered by atherosclerotic plaque rupture constitutes the core pathophysiological mechanism of acute coronary syndrome (ACS). In this process, coagulation system activation, platelet adhesion and aggregation, and fibrinolytic system dysfunction collectively determine thrombus formation, extension, and outcome. Von Willebrand factor (vWF), D-dimer, fibrin(ogen) degradation products (FDP), and fibrin monomer (FM)—as key molecular markers reflecting vascular endothelial function, thrombin generation, and fibrin formation and degradation—have garnered widespread attention in recent years for the assessment and prognostic evaluation of CAD. vWF, primarily synthesized by vascular endothelial cells, mediates platelet adhesion at sites of vascular injury and stabilizes coagulation factor VIII, thus directly reflecting endothelial status. Elevated D-dimer levels, as a degradation product of fibrin, indicate a hypercoagulable state and secondary hyperfibrinolysis. Given that hypercoagulability and hypofibrinolysis occur during CAD progression, D-dimer elevation serves as an important indicator for CAD severity assessment. This article systematically reviews the biological characteristics of the above four biomarkers and their correlations with the severity of coronary artery lesions and long-term prognosis, discusses the clinical utility of individual markers and their combined detection, and analyzes the limitations of existing studies as well as future directions.