Hognestad Aina, Endresen Knut, Wergeland Ragnhild, Stokke Oddvar, Geiran Odd, Holm Torbjorn, Simonsen Svein, Kjekshus John K, Andreassen Arne K
Department of Cardiology, Rikshospitalet, Oslo, Norway.
J Am Coll Cardiol. 2003 Aug 6;42(3):477-82. doi: 10.1016/s0735-1097(03)00645-4.
This study was initiated to determine whether heart transplant recipients (HTRs) with cardiac allograft vasculopathy (CAV) have increased levels of high-sensitivity C-reactive protein (hsCRP) and to examine whether an increase in hsCRP after heart transplantation predicts the development of CAV. Furthermore, the effect of pravastatin on plasma levels of hsCRP in HTRs was investigated.
The relationship between CAV and hsCRP, as well as the effect of statins on hsCRP in HTRs, has not been well established.
On referral for their annual angiographic control study, 150 consecutive HTRs (mean 6.5 years since transplantation) were included. Plasma levels of hsCRP were measured before angiography and compared with patients with (n = 52) and without (n = 98) CAV. In 49 of these patients, we additionally analyzed hsCRP in blood samples stored from their six-month visit after the transplantation procedure. Furthermore, in a randomized, crossover study, hsCRP was analyzed in 17 male HTRs before and after six weeks of treatment with 20 mg pravastatin.
Median levels of CRP were elevated among patients with CAV compared with those with normal angiograms [3.86 (1.78 to 7.00) vs. 1.08 (0.72 to 2.13) mg/l, p < 0.001]. Prospectively evaluated hsCRP levels from six months to follow-up were significantly higher among those who developed CAV compared with those with normal angiograms [+2.76 (1.56 to 5.00) vs. +0.07 (-0.57 to 0.41) mg/l, p < 0.001]. On multivariate analysis, the increase in hsCRP was the only significant predictor of CAV. Six weeks of treatment with pravastatin significantly reduced hsCRP levels by 25%, without any relation to changes in lipid values.
Elevated plasma levels of CRP are associated with angiographic evidence of CAV, and the increase in hsCRP is a strong predictor of development of CAV. Statin treatment reduces levels of hsCRP and should be used in HTRs, regardless of their lipid levels.
开展本研究以确定患有心脏移植血管病变（CAV）的心脏移植受者（HTR）的高敏C反应蛋白（hsCRP）水平是否升高，并探讨心脏移植后hsCRP升高是否可预测CAV的发生。此外，还研究了普伐他汀对HTR血浆hsCRP水平的影响。
CAV与hsCRP之间的关系以及他汀类药物对HTR中hsCRP的影响尚未完全明确。
在转诊进行年度血管造影对照研究时，纳入了150例连续的HTR（移植后平均6.5年）。在血管造影前测量血浆hsCRP水平，并与患有CAV（n = 52）和未患CAV（n = 98）的患者进行比较。在其中49例患者中，我们还分析了移植手术后6个月随访时储存血样中的hsCRP。此外，在一项随机交叉研究中，对17例男性HTR在接受20 mg普伐他汀治疗6周前后的hsCRP进行了分析。
与血管造影正常的患者相比，CAV患者的CRP中位数水平升高[3.86（1.78至7.00）对1.08（0.72至2.13）mg/l，p < 0.001]。与血管造影正常的患者相比，发生CAV的患者从6个月到随访期间前瞻性评估的hsCRP水平显著更高[+2.76（1.56至5.00）对+0.07（-0.57至0.41）mg/l，p < 0.001]。多因素分析显示，hsCRP升高是CAV唯一显著的预测因素。普伐他汀治疗6周可使hsCRP水平显著降低25%，且与血脂值变化无关。
血浆CRP水平升高与CAV的血管造影证据相关，hsCRP升高是CAV发生的有力预测因素。他汀类药物治疗可降低hsCRP水平，应在HTR中使用，无论其血脂水平如何。
