Khor Lillian L C, Muhlestein Joseph B, Carlquist John F, Horne Benjamin D, Bair Tami L, Maycock Chloe A, Anderson Jeffrey L
Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
Am J Med. 2004 Nov 1;117(9):657-64. doi: 10.1016/j.amjmed.2004.06.021.
To determine whether sex and age affect serum C-reactive protein level and its prognostic value in patients with coronary artery disease.
In a consecutive series of 2254 patients with angiographically defined coronary artery disease, baseline C-reactive protein and predictive value for incident death or nonfatal myocardial infarction by sex and age (<55 and > or =55 years) were compared. C-reactive protein levels were measured by fluorescence polarization immunoassay with use of a medium-sensitivity method. Patients were followed for a mean (+/-SD) of 3.1 +/- 2.2 years. Comparisons used ln-transformed C-reactive protein and linear and time-to-event regression analyses, adjusting for confounders.
Overall, women had higher geometric mean C-reactive protein levels than did men (1.47 vs. 1.30 mg/dL, P <0.001), even after adjustment for age, hyperlipidemia, diabetes, prior myocardial infarction, body mass index, and heart failure (P = 0.002). High C-reactive protein levels were associated with increased mortality or myocardial infarction among men (adjusted hazard ratio [HR] = 1.9; 95% confidence interval [CI]: 1.5 to 2.3) but not among women (HR = 1.0; 95% CI: 0.69 to 1.4). Among patients aged <55 years, C-reactive protein level was similarly predictive in men and women (HR = 2.2 vs. 2.7), whereas in patients > or =55 years of age, it remained predictive for men (HR = 1.8; 95% CI: 1.5 to 2.3) but not women (HR = 0.93; 95% CI: 0.63 to 1.4).
We found that the prognostic value of C-reactive protein in coronary artery disease patients varied by sex and age. This sex-age interaction may have important implications for C-reactive protein-based secondary risk assessment and requires further investigation.
确定性别和年龄是否会影响冠心病患者的血清C反应蛋白水平及其预后价值。
在连续纳入的2254例经血管造影确诊为冠心病的患者中，比较基线C反应蛋白水平以及按性别和年龄（<55岁和≥55岁）划分的发生死亡或非致死性心肌梗死的预测价值。采用中灵敏度方法通过荧光偏振免疫测定法测量C反应蛋白水平。对患者进行了平均（±标准差）3.1±2.2年的随访。比较采用对数转换后的C反应蛋白以及线性和事件发生时间回归分析，并对混杂因素进行了校正。
总体而言，即使在对年龄、高脂血症、糖尿病、既往心肌梗死、体重指数和心力衰竭进行校正后，女性的几何平均C反应蛋白水平仍高于男性（1.47 vs. 1.30 mg/dL，P<0.001；校正后P = 0.002）。高C反应蛋白水平与男性死亡率或心肌梗死增加相关（校正风险比[HR]=1.9；95%置信区间[CI]：1.5至2.3），但与女性无关（HR = 1.0；95% CI：0.69至1.4）。在年龄<55岁的患者中，C反应蛋白水平在男性和女性中具有相似的预测性（HR = 2.2 vs. 2.7），而在年龄≥55岁的患者中，它对男性仍具有预测性（HR = 1.8；95% CI：1.5至2.3），但对女性则无预测性（HR = 0.93；95% CI：0.63至1.4）。
我们发现C反应蛋白在冠心病患者中的预后价值因性别和年龄而异。这种性别 - 年龄相互作用可能对基于C反应蛋白的二级风险评估具有重要意义，需要进一步研究。
