Vitale Cristiana, Cerquetani Elena, Wajngarten Maurício, Leonardo Filippo, Silvestri Antonello, Mercuro Giuseppe, Fini Massimo, Ramires Josè Antonio, Rosano Giuseppe M
Cardiovascular Research Unit, Department of Medical Sciences, San Raffaele-Rome, Tosinvest Sanità, Rome, Italy.
Ital Heart J. 2003 Sep;4(9):627-32.
Endothelial function is impaired in patients with coronary artery disease (CAD); in these patients plasma levels of C-reactive protein (CRP) and impaired endothelial function are related to future cardiac events. The aim of the present study was to evaluate the effects of medical therapy on endothelial function and CRP in patients with CAD.
Seventy-three patients (52 men, 21 women, mean age 66 +/- 9 years) with CAD and 32 control subjects (25 men, 7 women, mean age 65 +/- 11 years) were enrolled in the study. The endothelial function was evaluated by means of flow-mediated dilation (FMD) of the brachial artery following ischemia and CRP by means of a high-sensitivity assay. After baseline evaluation of CRP and FMD all patients received full medical therapy for 3 months and were then again tested for endothelial function and CRP.
Compared to healthy controls, patients had significantly more impaired endothelial function (FMD 3.6 +/- 3.2 vs 8 +/- 2.4%, p < 0.01) and higher CRP plasma levels (1.6 +/- 0.9 vs 0.9 +/- 0.56 mg/dl, p < 0.05). At baseline a significant negative correlation was found between CRP plasma levels and FMD in patients with CAD (r = -0.56, p < 0.05) while no correlation was found in controls. Medical therapy resulted in a significant improvement in endothelial function (3.64 +/- 3 vs 7.2 +/- 3.5%, p < 0.01), and a decrease of CRP (-0.26 +/- 0.19, p < 0.01); the changes in CRP and FMD were independent of the drug used. A positive correlation was found between the improvement in FMD and the degree of CRP reduction (r = 0.57, p < 0.01).
In patients with CAD plasma levels of CRP are associated with an impaired endothelial function suggesting a correlation between inflammation and the integrity of the endothelium. Full medical therapy reduces CRP with a parallel improvement in endothelial function.
冠心病（CAD）患者存在内皮功能受损；在这些患者中，血浆C反应蛋白（CRP）水平及内皮功能受损与未来心脏事件相关。本研究旨在评估药物治疗对CAD患者内皮功能和CRP的影响。
本研究纳入了73例CAD患者（52例男性，21例女性，平均年龄66±9岁）和32例对照者（25例男性，7例女性，平均年龄65±11岁）。通过缺血后肱动脉的血流介导的血管舒张（FMD）评估内皮功能，通过高敏检测法测定CRP。在对CRP和FMD进行基线评估后，所有患者接受了3个月的全面药物治疗，然后再次检测内皮功能和CRP。
与健康对照者相比，患者的内皮功能受损明显更严重（FMD：3.6±3.2%对8±2.4%，p<0.01），血浆CRP水平更高（1.6±0.9mg/dl对0.9±0.56mg/dl，p<0.05）。在CAD患者中，基线时血浆CRP水平与FMD之间存在显著负相关（r=-0.56，p<0.05），而在对照者中未发现相关性。药物治疗使内皮功能得到显著改善（3.64±3%对7.2±3.5%，p<0.01），CRP降低（-0.26±0.19，p<0.01）；CRP和FMD的变化与所用药物无关。FMD改善程度与CRP降低程度之间存在正相关（r=0.57，p<0.01）。
在CAD患者中，血浆CRP水平与内皮功能受损相关，提示炎症与内皮完整性之间存在关联。全面药物治疗可降低CRP，同时内皮功能得到改善。
