Libby Peter, Ridker Paul M
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Am J Med. 2004 Mar 22;116 Suppl 6A:9S-16S. doi: 10.1016/j.amjmed.2004.02.006.
Inflammation participates critically in atherosclerosis. Circulating levels of several inflammatory markers rise in individuals at risk for atherosclerotic events. In particular, elevation of plasma C-reactive protein (CRP), a nonspecific acute-phase reactant that is easily and reliably measured, has strong predictive power for cardiovascular events. Indeed, measurements of high-sensitivity CRP (hs-CRP) plasma levels add to both the prognostic information gleaned from assay of plasma lipid risk factors and the risk levels estimated by means of Framingham study-based criteria. Retrospective data suggest the hypothesis that hs-CRP plasma levels may be useful for guiding use of lipid-lowering therapy in individuals who appear to be at low risk according to traditional risk assessment. A large-scale, randomized clinical trial-Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)-will test whether rosuvastatin therapy will reduce incident cardiovascular disease in subjects with elevated plasma hs-CRP concentrations who do not meet current criteria for initiation of lipid-lowering drug therapy. Such clinical trial data may provide an evidence base for the use of plasma CRP assay as an adjuvant guide to therapy to complement the established traditional risk factors such as plasma lipid levels. Thus, medical practitioners are ushering in an era in which the biology of inflammation in atherosclerosis will find its way into clinical application.
炎症在动脉粥样硬化中起着关键作用。在有动脉粥样硬化事件风险的个体中，几种炎症标志物的循环水平会升高。特别是，血浆C反应蛋白（CRP）——一种易于且可靠测量的非特异性急性期反应物——的升高对心血管事件具有很强的预测能力。事实上，高敏CRP（hs-CRP）血浆水平的测量既增加了从血浆脂质风险因素检测中获得的预后信息，也增加了通过基于弗雷明汉研究的标准估算的风险水平。回顾性数据提出了这样一个假设，即hs-CRP血浆水平可能有助于指导对那些根据传统风险评估似乎处于低风险的个体使用降脂治疗。一项大规模、随机临床试验——《他汀类药物在一级预防中的应用：评估瑞舒伐他汀的干预试验》（JUPITER）——将测试瑞舒伐他汀治疗是否会降低血浆hs-CRP浓度升高但不符合当前启动降脂药物治疗标准的受试者发生心血管疾病的风险。此类临床试验数据可能为将血浆CRP检测用作辅助治疗指南以补充既定的传统风险因素（如血浆脂质水平）提供证据基础。因此，医学从业者正在迎来一个动脉粥样硬化炎症生物学将应用于临床的时代。
