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高敏C反应蛋白结合血脂可以更好预测急性冠脉综合征患者的长期预后

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第6期
页码:
813-816
栏目:
临床研究
出版日期:
2009-11-05

文章信息/Info

Title:
Long-term prognostic value of high-sensitivity C-reactive protein and its combination with serum cholesterol in acute coronary syndrome
作者:
侯晓霞1; 王雷2; 胡大一3
首都医科大学:1.附属北京同仁医院心血管中心，北京100730，2.附属北京友谊医院 心血管疾病诊治研究中心，北京 100054；3.北京大学人民医院心脏中心，北京100044
Author(s):
HOU Xiao-xia1;  WANG Lei2;  HU Da-yi3
1.Cardiovascular Center, Beijing Tongren Hospital, Beijing 100730, China, 2.Heart & Blood Vessel Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100054, China; 3.Heart Center, People's Hospital, Peking University, Beijing 100044, China
关键词:
C反应蛋白; 急性冠脉综合征; 预后; 长期
Keywords:
C-reactive protein;  acute coronary syndrome;  long-term prognosis
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的: 评价高敏C反应蛋白（hs-CRP）及其联合血脂对急性冠脉综合征（ACS）患者长期预后的预测价值。方法: 连续入选ACS患者246名，测定其入院时的hs-CRP和肌钙蛋白T（cTnT）水平以及基线的血清总胆固醇、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）等指标。观察住院及随访期间（40±6）个月主要心血管事件的发生情况，据此将患者分为事件组和对照组。根据两组中有显著差异的临床指标，筛选对终点事件有独立预测价值的指标。依据所筛选独立预测指标的不同水平，对患者进行危险分层，观察不同危险组患者的主要心血管事件发生率。所有资料均采用SPSS13.0软件进行分析。结果: 完成随访241例，失访率2.0%，其中121例发生心血管事件。事件组和对照组患者的年龄、白细胞计数、hs-CRP、LDL-C/HDL-C和cTnT阳性率均有显著差异（P<0.05），行Logistic回归分析后只有hs-CRP和LDL-C/HDL-C进入回归方程（P<0.01）。分别根据hs-CRP和LDL-C/HDL-C的三分位数对患者进行危险分层，发现随着hs-CRP和LDL-C/HDL-C的升高，患者的心血管事件发生率均呈上升趋势（均P＜0.05）。对于LDL-C/HDL-C<2.75的患者，hs-CRP可进一步分层，识别出危险性相对较高者。结论: hs-CRP可以独立预测ACS患者长期再发心血管事件的危险；结合血脂，其危险分层作用更强。
Abstract:
AIM: To evaluate the long-term prognostic value of high-sensitivity C-reactive protein and its combination with serum cholesterol in patients with acute coronary syndrome (ACS). METHODS: A total of 246 consecutive patients diagnosed with ACS were included. Their hs-CRP concentration and cardiac troponin T (cTnT) on admission and baseline levels of lipids profile were determined. The major adverse cardiovascular events (MACE) including cardiac death, recurrent nonfatal myocardial infarction and readmission for severe angina in the hospital and during the follow-up period were registered and accordingly, patients were divided into study group (n=121) and control group (n=120). Clinical features of the two groups were compared. Risk stratifications were made based on the different levels of independent predictors for MACE. RESULTS: There were 241 subjects who completed the whole study. One hundred twenty-one cases presented with MACE, including 47 cases of cardiac death. The disparity of age and baseline levels of white blood cell (WBC) counts, hs-CRP, LDL-C/HDL-C and cTnT were statistically significant between groups (P<0.05). Hs-CRP and LDL-C/HDL-C were independent predictors of MACE when adjusted by age and baseline levels of WBC counts and cTnT. The risk of MACE increased with the increment of hs-CRP and LDL-C/HDL-C, respectively (both P<0.05). As for patients in the lowest tertile of LDL-C/HDL-C, higher hs-CRP levels indicated higher risk. Patients with hs-CRP and LDL-C/HDL-C both in the highest tertile had the highest events rates (74.2%). CONCLUSION: Hs-CRP has independent prognostic value for the long-term outcome of recurrent cardiovascular events in ACS and shows incremental prediction in combination with blood cholesterol.

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备注/Memo

备注/Memo:
收稿日期：2008-1-15.通讯作者：胡大一，教授，主要从事心电生理和冠心病介入治疗研究Email:dayihu@ccheart.com 作者简介：侯晓霞，主治医师，硕士Email：joycellet@126.com
更新日期/Last Update: 2009-09-30