术前高敏C反应蛋白水平升高与冠状动脉支架置入成功后的新生内膜增生和再狭窄发生相关。

Elevated preprocedural high-sensitivity C-reactive protein levels are associated with neointimal hyperplasia and restenosis development after successful coronary artery stenting.

作者信息

Hong Young Joon, Jeong Myung Ho, Lim Sang Yup, Lee Sang Rok, Kim Kye Hun, Sohn Il Suk, Park Hyung Wook, Kim Ju Han, Kim Weon, Ahn Youngkeun, Cho Jeong Gwan, Park Jong Chun, Kang Jung Chaee

机构信息

The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.

出版信息

Circ J. 2005 Dec;69(12):1477-83. doi: 10.1253/circj.69.1477.

DOI:10.1253/circj.69.1477

PMID:16308495

Abstract

BACKGROUND

Recent data indicate that an elevated serum level of high-sensitivity C-reactive protein (hs-CRP) predicts the risk of recurrent coronary events, and that statin therapy decreases the risk of coronary events. This study assessed the relationship between the pre-procedural hs-CRP level and in-stent neointimal hyperplasia (NIH) after stenting and the effects of statins on the relationship between restenosis after stenting and the serum hs-CRP levels of patients with coronary artery disease.

METHODS AND RESULTS

This study included 100 patients who underwent stent implantation for angiographically significant stenosis. Patients were divided into a normal C-reactive protein (CRP) group (<0.5 mg/dl, n=59) and elevated CRP group (>or=0.5 mg/dl, n=41). All patients underwent angiographic and intravascular ultrasound follow-up at 6 months. The baseline CRP level was 0.29+/-0.08 mg/dl in the normal CRP group and 2.90+/-2.31 mg/dl in the elevated CRP group. The NIH cross-sectional area (CSA) in the minimal lumen CSA at follow-up was significantly larger in the elevated CRP group compared with the normal CRP group (1.9+/-1.3 mm2 vs 3.0+/-1.5 mm2, p=0.001). A significant positive correlation was found between pre-interventional CRP level and NIH area (r=0.52, p<0.001). In patients with normal CRP, an association between statin therapy and restenosis was not observed. However, when the analysis was confined to patients with elevated CRP, statin therapy significantly reduced the restenosis rate (20% vs 37.5%, p=0.031). In the normal CRP group, the intra-stent neointimal area at 6 months was not different between the non-statin and statin groups (2.2+/-1.4 mm2 vs 1.8+/-1.1 mm2). However, in the elevated CRP group, statin therapy significantly decreased the neointimal area at 6-month follow-up (3.6+/-1.7 mm2 vs 2.4+/-1.3 mm2, p<0.001).

CONCLUSION

Measuring the pre-interventional hs-CRP level may help predict the development of restenosis after stenting and statin therapy will significantly reduce the restenosis rate in patients with an elevated hs-CRP.

摘要

背景

近期数据表明，血清高敏C反应蛋白（hs-CRP）水平升高可预测冠状动脉事件复发风险，且他汀类药物治疗可降低冠状动脉事件风险。本研究评估了冠状动脉疾病患者介入治疗前hs-CRP水平与支架置入术后支架内新生内膜增生（NIH）之间的关系，以及他汀类药物对支架置入术后再狭窄与血清hs-CRP水平关系的影响。

方法与结果

本研究纳入100例因血管造影显示明显狭窄而接受支架植入的患者。患者分为C反应蛋白（CRP）正常组（<0.5mg/dl，n=59）和CRP升高组（≥0.5mg/dl，n=41）。所有患者在6个月时接受血管造影和血管内超声随访。CRP正常组的基线CRP水平为0.29±0.08mg/dl，CRP升高组为2.90±2.31mg/dl。随访时，CRP升高组最小管腔横截面积处的NIH横截面积显著大于CRP正常组（分别为1.9±1.3mm²和3.0±1.5mm²，p=0.001）。介入治疗前CRP水平与NIH面积之间存在显著正相关（r=0.52 p<0.001）。在CRP正常的患者中，未观察到他汀类药物治疗与再狭窄之间的关联。然而，当分析仅限于CRP升高的患者时，他汀类药物治疗显著降低了再狭窄率（分别为20%和37.5%，p=0.）。在CRP正常组中，非他汀类药物组和他汀类药物组在6个月时的支架内新生内膜面积无差异（分别为2.2±1.4mm²和1.8±1.1mm²）。然而，在CRP升高组中，他汀类药物治疗在6个月随访时显著降低了新生内膜面积（分别为3.6±1.7mm²和2.4±1.3mm²，p<0.001）。