Auer J, Rammer M, Berent R, Weber T, Lassnig E, Eber B
2nd Medical Department, General Hospital Wels, Austria.
Indian Heart J. 2002 May-Jun;54(3):284-8.
C-reactive protein is a valid marker of cardiovascular risk. It is not known whether C-reactive protein is a marker of atherosclerotic burden or whether it reflects a process (e.g. inflammatory fibrous cap degradation) leading to acute coronary events. This study was performed to determine whetherthe concentration of C-reactive protein is associated with coronary atherosclerosis assessed by coronary angiography.
We studied a total of 100 men and women (41 women, 59 men, mean age 63.7 +/- 11.0 years) who were referred for coronary angiography. Baseline data collection comprised clinical characteristics and conventional risk factors for coronary artery disease, levels of serum lipids and fasting total homocysteine levels. The relation between serum C-reactive protein levels and the severity and extension of coronary lesions was studied. The coronary angiograms were evaluated in a blinded manner according to three scores: vessel score (0-3 points for 0-3 vessels with coronary artery disease), stenosis score (0-3 points: number and severity of coronary stenoses or lesions; 0 for no, 1 for coronary lesion with diameter stenosis less than 50%, 2 for 50%-75%, and 3 for more than 75% diameter stenosis), and extent score (0-3 points; segment-extension of all coronary lesions within the total coronary vessel length). According to the total score values obtained, groups for coronary artery disease risk were defined and analyzed forcorrelations with age and levels of total cholesterol. high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, fasting total homocysteine. and C-reactive protein in serum. From the 100 patients, 40 were found to have no or minimal coronary artery disease (group A; score 0-3), 33 had moderate (group B; score 4-8) and 27 had severe (group C: score more than 8) coronary artery disease assessed by coronary angiography. Estimates of the relative risk of coronary heart disease for the third quintile of serum C-reactive protein as compared with the first quintile were 1.79 (95 percent confidence interval 1.23-2.39). Serum C-reactive protein levels were 3.54 (+/- 7.07) mg/L, 11.41 (+/- 13.5) mg/L and 5.66 (+/- 8.32) mg/L in groups A, B and C and represented an independent risk factor for the presence of coronary artery disease assessed by coronary angiography (p<0.01). With step-wise logistic regression analyses, use of C-reactive protein values maintained the ability to predict the probability of coronary artery disease. Moreover, the presence of angiographic coronary artery disease was associated with patient age (p=0.048), male sex (p<0.01), high LDL-cholesterol levels (p=0.02), low HDL-cholesterol levels (p=0.02), high plasma fibrinogen levels (p<0.01) and high fasting total homocysteine levels (p=0.04).
These results suggest that the serum concentration of C-reactive protein is associated with presence, but not severity, of coronary artery disease in patients referred for coronary angiography.
C反应蛋白是心血管风险的有效标志物。目前尚不清楚C反应蛋白是动脉粥样硬化负担的标志物，还是反映导致急性冠状动脉事件的过程（如炎性纤维帽降解）。本研究旨在确定C反应蛋白浓度是否与冠状动脉造影评估的冠状动脉粥样硬化相关。
我们共研究了100名因冠状动脉造影而就诊的男性和女性（41名女性，59名男性，平均年龄63.7±11.0岁）。基线数据收集包括临床特征、冠状动脉疾病的传统危险因素、血脂水平和空腹总同型半胱氨酸水平。研究血清C反应蛋白水平与冠状动脉病变严重程度和范围之间的关系。根据三个评分对冠状动脉造影进行盲法评估：血管评分（0-3分，代表0-3支患有冠状动脉疾病的血管）、狭窄评分（0-3分：冠状动脉狭窄或病变的数量和严重程度；无病变为0分，直径狭窄小于50%的冠状动脉病变为1分，50%-75%为2分，直径狭窄超过75%为3分）和范围评分（0-3分；所有冠状动脉病变在总冠状动脉长度内的节段延伸）。根据获得的总分值，定义冠状动脉疾病风险组，并分析其与年龄以及血清总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、空腹总同型半胱氨酸和C反应蛋白水平的相关性。在100例患者中，40例被发现无或仅有轻微冠状动脉疾病（A组；评分0-3），33例有中度疾病（B组；评分4-8），27例有重度疾病（C组：评分超过8），均通过冠状动脉造影评估。血清C反应蛋白第三五分位数与第一五分位数相比，冠心病相对风险估计值为1.79（95%置信区间1.23-2.39）。A、B和C组血清C反应蛋白水平分别为3.54（±7.07）mg/L、11.41（±13.5）mg/L和5.66（±8.32）mg/L，是冠状动脉造影评估的冠状动脉疾病存在的独立危险因素（p<0.01）。通过逐步逻辑回归分析，使用C反应蛋白值仍能预测冠状动脉疾病的概率。此外，冠状动脉造影显示的冠状动脉疾病与患者年龄（p=0.048）、男性（p<0.01）、高LDL胆固醇水平（p=0.02）、低HDL胆固醇水平（p=0.02）、高血浆纤维蛋白原水平（p<0.01）和高空腹总同型半胱氨酸水平（p=0.04）相关。
这些结果表明，在因冠状动脉造影而就诊的患者中，血清C反应蛋白浓度与冠状动脉疾病的存在相关，但与严重程度无关。
