Zebrack James S, Muhlestein Joseph B, Horne Benjamin D, Anderson Jeffrey L
Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
J Am Coll Cardiol. 2002 Feb 20;39(4):632-7. doi: 10.1016/s0735-1097(01)01804-6.
The objective of this study was to determine the prognostic value of C-reactive protein (CRP) independent of coronary angiographic findings.
High sensitivity CRP, a marker of inflammation, predicts risk of cardiovascular events. However, it is uncertain whether it remains predictive once angiographic findings are considered.
A total of 2,554 patients with angina but without acute myocardial infarction (MI) were studied angiographically; 1,848 patients had coronary artery disease (CAD) and 706 patients did not. Coronary artery disease was quantified in five ways and combined for a CAD score. C-reactive protein was measured and patients were followed for up to five years for death or MI.
C-reactive protein correlated with the extent of CAD, but correlation coefficients were low (0.02 to 0.08). Of angiographic measures, the CAD score best predicted future events (hazard ratio [HR] = 1.8 [1.2 to 2.6], p = 0.004, for CAD score > 4). C-reactive protein > or = 1.0 mg/dl was predictive in both patients without CAD (HR = 2.3 [0.9 to 5.5], p = 0.07) and with CAD (HR = 2.1 [1.5 to 3.1], p = 0.0001). Multivariate adjustment resulted in little change in HR. C-reactive protein retained predictive value within each quintile of CAD score. C-reactive protein and CAD independently and additively contributed to the risk prediction: low CRP and lowest CAD score was associated with lowest risk, and high CRP and highest CAD score was associated with the highest risk, with a 10-fold difference between extremes (2.5% vs. 24%).
C-reactive protein correlates with extent of CAD, but the degree of correlation is low. Severity/extent of CAD and CRP are independent and additive predictors of risk. Therapy should target CRP-associated risk as well as angiographically evident stenosis.
本研究的目的是确定独立于冠状动脉造影结果的C反应蛋白（CRP）的预后价值。
高敏CRP作为一种炎症标志物，可预测心血管事件风险。然而，一旦考虑造影结果，其是否仍具有预测性尚不确定。
对总共2554例有胸痛但无急性心肌梗死（MI）的患者进行了血管造影研究；其中1848例患有冠状动脉疾病（CAD），706例没有。冠状动脉疾病通过五种方式进行量化，并合并得出CAD评分。检测C反应蛋白，并对患者进行长达五年的随访，观察死亡或MI情况。
C反应蛋白与CAD程度相关，但相关系数较低（0.02至0.08）。在血管造影测量指标中，CAD评分对未来事件的预测效果最佳（CAD评分>4时，风险比[HR]=1.8[1.2至2.6]，p=0.004）。CRP≥1.0mg/dl在无CAD患者（HR=2.3[0.9至5.5]，p=0.07）和有CAD患者（HR=2.1[1.5至3.1]，p=0.0001）中均具有预测性。多变量调整后HR变化不大。在CAD评分的每个五分位数内，C反应蛋白均保留了预测价值。C反应蛋白和CAD独立且相加地对风险预测产生影响：低CRP和最低CAD评分与最低风险相关，高CRP和最高CAD评分与最高风险相关，两者极端情况相差10倍（2.5%对24%）。
C反应蛋白与CAD程度相关，但相关程度较低。CAD的严重程度/范围和CRP是风险的独立且相加的预测指标。治疗应针对与CRP相关的风险以及血管造影显示的狭窄。
