[C反应蛋白和肌钙蛋白T水平在不稳定型心绞痛患者中的预后价值]

[Prognostic value of C-reactive protein and troponin T level in patients with unstable angina pectoris].

作者信息

Tanaka Hiroyuki, Tsurumi Yukio, Kasanuki Hiroshi

机构信息

Department of Cardiology, Tokyo Women's Medical University, Tokyo.

出版信息

J Cardiol. 2006 Apr;47(4):173-9.

PMID:16637251

Abstract

OBJECTIVES

The prognosis of unstable angina pectoris may be more accurately predicted by the combination of C-reactive protein (CRP), which is a known inflammation marker, and troponin T (TnT), which is used for risk assessment for the prognosis of acute coronary syndrome. The present study investigated the correlations between pathophysiology and prognosis of severe unstable angina pectoris and CRP and TnT levels.

METHODS

The correlation between CRP at admission and the prognosis was studied in 367 patients with severe unstable angina pectoris (Braunwald type II and III) who were admitted to our hospital between January 1998 and December 2000. The in-hospital and long-term prognosis was investigated in TnT-positive patients. In-hospital cardiac events were defined as death, myocardial infarction, heart failure and angina attacks during hospitalization. Long-term cardiac events were defined as death, myocardial infarction, heart failure and recurrence of angina.

RESULTS

The incidence of in-hospital cardiac events in all patients was 30.2%. The CRP levels were higher in patients with cardiac events (0.97 +/- 2.67 vs 0.53 +/- 1.29 mg/d/, p = 0.057), but there was no significant difference between the two groups. The incidence of long-term cardiac events was 26.8%. The mean CRP level was significantly higher in patients with cardiac events than in patients without cardiac events (1.17 +/- 1.86 vs 0.43 +/- 1.14 mg/dl, p = 0.098). In TnT-positive patients (TnT > 0.1 ng/ml, 23% of all patients), the incidence of in-hospital cardiac events was 47.6% (p < 0.0001), significantly higher than that in all patients. TnT-positive patients with CRP levels of 0.5 mg/dl or higher (8% of all patients) had a markedly higher incidence of in-hospital cardiac events of 56.7% (p = 0.001) and long-term cardiac events of 46.7% (p = 0.01).

CONCLUSIONS

CRP levels were useful in prediction of the long-term prognosis. TnT levels were useful in prediction of in-hospital prognosis. The present study suggested the possibility that the combined use of these biological markers could predict the prognosis of patients with unstable angina at early stage and more accurately.

摘要

目的

已知炎症标志物C反应蛋白（CRP）与用于急性冠状动脉综合征预后风险评估的肌钙蛋白T（TnT）联合使用，可能更准确地预测不稳定型心绞痛的预后。本研究调查了重度不稳定型心绞痛的病理生理学与预后以及CRP和TnT水平之间的相关性。

方法

研究了1998年1月至2000年12月期间我院收治的367例重度不稳定型心绞痛（Braunwald II型和III型）患者入院时CRP与预后的相关性。对TnT阳性患者的住院期间及长期预后进行了调查。住院期间心脏事件定义为住院期间的死亡、心肌梗死、心力衰竭和心绞痛发作。长期心脏事件定义为死亡、心肌梗死、心力衰竭和心绞痛复发。

结果

所有患者住院期间心脏事件的发生率为30.2%。发生心脏事件的患者CRP水平较高（0.97±2.67 vs 0.53±1.29mg/dl，p = 0.057），但两组之间无显著差异。长期心脏事件的发生率为26.8%。发生心脏事件的患者平均CRP水平显著高于未发生心脏事件的患者（1.17±1.86 vs 0.43±1.14mg/dl，p = 0.098）。在TnT阳性患者（TnT>0.1ng/ml，占所有患者的23%）中，住院期间心脏事件的发生率为47.6%（p<0.0001），显著高于所有患者。CRP水平为0.5mg/dl或更高的TnT阳性患者（占所有患者的8%）住院期间心脏事件的发生率显著更高，为56.7%（p = 0.001），长期心脏事件的发生率为46.7%（p = 0.01）。