急性心肌梗死中的急性期反应物：对5年预后的影响。

Acute-phase reactants in acute myocardial infarction: impact on 5-year prognosis.

作者信息

Mariotti R, Musumeci G, De Carlo M, Biadi O, Caravelli P, Limbruno U, Mariani M

机构信息

Cardio Thoracic Department, University of Pisa, Italy.

出版信息

Ital Heart J. 2001 Apr;2(4):294-300.

PMID:11374499

Abstract

BACKGROUND

Acute-phase reactants have recently been shown to have a short-term and possibly long-term prognostic value in acute coronary syndromes. The aim of the present study was to retrospectively verify whether serum levels of inflammation markers can predict the occurrence of early and late cardiac events after myocardial infarction.

METHODS

We reevaluated 58 consecutive patients (43 men and 15 women, mean age 66 +/- 12 years) admitted to our Center during 1993 with a first myocardial infarction. Patients with non-cardiac causes of inflammation were excluded, as well as patients with a left ventricular ejection fraction <40%. From the first blood sample obtained at admission, we evaluated C-reactive protein (CRP) and alpha1-acid glycoprotein (alpha1-AGP) serum levels, the erythrocyte sedimentation rate (ESR), fibrinogen levels, and the white blood cell (WBC) count. We also evaluated the highest level of serum cardiac markers. Follow-up data were collected for 55 patients in June 1999.

RESULTS

Five in-hospital and 13 delayed cardiac deaths occurred. The mean follow-up of current survivors was 5.9 +/- 0.4 years. Patients in whom cardiac death occurred had significantly higher CRP (7.4 +/- 4.1 vs 3.0 +/- 2.4 mg/dl, p < 0.001) and alpha1-AGP levels (160 +/- 38 vs 113 +/- 24 mg/dl, p < 0.001), ESR (63 +/- 30 vs 37 +/- 25 mm/hour, p < 0.001), and WBC count (13,727 +/- 3,853 vs 10,936 +/- 3,358/mm3, p = 0.004). At multivariate analysis, higher alpha1-AGP (p < 0.001) and CRP serum levels (p = 0.02) were independent predictors of cardiac death. Patients in whom cardiac events occurred during follow-up showed higher CRP (5.7 +/- 3.7 vs 1.6 +/- 1.5 mg/dl, p < 0.001) and alpha1-AGP levels (140 +/- 36 vs 101 +/- 23 mg/dl, p < 0.001) and ESR (50 +/- 30 vs 34 +/- 26 mm/hour, p = 0.06). Higher alpha1-AGP (p < 0.001) and CRP serum levels (p = 0.03) were independent predictors of the occurrence of cardiac events.

CONCLUSIONS

The present study shows that CRP and alpha1-AGP have an independent prognostic value in patients presenting with a first, uncomplicated myocardial infarction. Assays of these markers may help to better stratify patients hospitalized for acute coronary syndromes.

摘要

背景

近期研究表明，急性期反应物在急性冠状动脉综合征中具有短期乃至可能的长期预后价值。本研究旨在回顾性验证炎症标志物的血清水平能否预测心肌梗死后早期和晚期心脏事件的发生。

方法

我们重新评估了1993年期间连续入住本中心的58例首次发生心肌梗死的患者（43例男性和15例女性，平均年龄66±12岁）。排除非心脏原因引起炎症的患者以及左心室射血分数<40%的患者。从入院时采集的第一份血样中，我们评估了C反应蛋白（CRP）和α1-酸性糖蛋白（α1-AGP）的血清水平、红细胞沉降率（ESR）、纤维蛋白原水平以及白细胞（WBC）计数。我们还评估了血清心脏标志物的最高水平。1999年6月收集了55例患者的随访数据。

结果

发生了5例院内心脏死亡和13例延迟性心脏死亡。当前幸存者的平均随访时间为5.9±0.4年。发生心脏死亡的患者CRP水平（7.4±4.1 vs 3.0±2.4mg/dl，p<0.001）、α1-AGP水平（160±38 vs 113±24mg/dl，p<0.001）、ESR（63±30 vs 37±25mm/小时，p<0.001）和WBC计数（13,727±3,853 vs 10,936±3,358/mm³，p = 0.004）显著更高。多因素分析显示，较高的α1-AGP（p<0.001）和CRP血清水平（p = 0.02）是心脏死亡的独立预测因素。随访期间发生心脏事件的患者CRP水平（5.7±3.7 vs 1.6±1.5mg/dl，p<0.001）、α1-AGP水平（140±36 vs 101±23mg/dl，p<0.001）和ESR（50±30 vs 34±26mm/小时，p = 0.06）更高。较高的α1-AGP（p<0.001）和CRP血清水平（p = 0.03）是心脏事件发生的独立预测因素。