Tsimikas Sotirios, Willerson James T, Ridker Paul M
Department of Medicine, Division of Cardiology, University of California, San Diego, San Diego, California 92093-0682, USA.
J Am Coll Cardiol. 2006 Apr 18;47(8 Suppl):C19-31. doi: 10.1016/j.jacc.2005.10.066.
Several emerging plasma biomarkers may ultimately prove useful in risk stratification and prognosis of cardiovascular disease. The clinical utility of these biomarkers will depend on their ability to provide a reflection of the underlying atherosclerotic burden or activity; the ability to provide reliable, accurate, and cost-effective information; and the ability to predict future events. High-sensitivity C-reactive protein (hs-CRP) fulfills many, if not all, of these criteria, and blood levels of hs-CRP are now commonly used in clinical practice to improve vascular risk prediction in primary and secondary prevention across all levels of low-density lipoprotein-cholesterol (LDL-C), all levels of the Framingham Risk Score, and all levels of metabolic syndrome. High-sensitivity C-reactive protein may also have clinical relevance as an adjunct to LDL-C for both the targeting and monitoring of statin therapy. Accumulating evidence suggests that several other selected emerging biomarkers may also potentially prove useful in the diagnosis and prognosis of cardiovascular disease. Specifically, data are accumulating on the potential clinical utility of lipoprotein-associated lipoprotein-associated phospholipase A2, myeloperoxidase, oxidized LDL, lipoprotein (a), isoprostanes, and small, dense LDL. This review focuses on hs-CRP and these emerging plasma biomarkers, and their potential diagnostic and prognostic utility in cardiovascular disease. Plasma biomarkers that reflect the clinical potential of atherothrombotic disease may allow more precise risk stratification and prognostication in high-risk populations, and perhaps earlier diagnosis and intervention in patients at risk for or with occult cardiovascular disease.
几种新出现的血浆生物标志物最终可能被证明对心血管疾病的风险分层和预后评估有用。这些生物标志物的临床效用将取决于它们反映潜在动脉粥样硬化负担或活动的能力；提供可靠、准确且具有成本效益信息的能力；以及预测未来事件的能力。高敏C反应蛋白（hs-CRP）满足了许多（即便不是全部）这些标准，目前hs-CRP的血液水平在临床实践中普遍用于改善各级低密度脂蛋白胆固醇（LDL-C）、各水平弗明汉姆风险评分以及各水平代谢综合征患者在一级和二级预防中的血管风险预测。高敏C反应蛋白作为LDL-C的辅助指标，在他汀类药物治疗的靶向和监测方面也可能具有临床意义。越来越多的证据表明，其他几种选定的新出现生物标志物在心血管疾病的诊断和预后评估中也可能具有潜在用途。具体而言，关于脂蛋白相关磷脂酶A2、髓过氧化物酶、氧化型LDL、脂蛋白（a）、异前列腺素和小而密LDL潜在临床效用的数据正在不断积累。本综述重点关注hs-CRP以及这些新出现的血浆生物标志物，及其在心血管疾病中的潜在诊断和预后效用。反映动脉粥样硬化血栓形成疾病临床潜力的血浆生物标志物可能使高危人群的风险分层和预后评估更加精确，或许还能对有隐匿性心血管疾病风险或已患该病的患者进行更早的诊断和干预。
