de Ferranti Sarah D, Rifai Nader
Department of Cardiology, Children's Hospital Boston and Harvard University School of Medicine, Boston, MA 02115, USA.
Cardiovasc Pathol. 2007 Jan-Feb;16(1):14-21. doi: 10.1016/j.carpath.2006.04.006.
Cardiovascular disease (CVD) is multifactorial in etiology. Traditional cardiovascular risk factors, such as increased cholesterol concentrations and blood pressure, are used to assess CVD risk. Recently, better understanding of the role of inflammation in atherosclerosis has prompted many to propose the measurement of various inflammatory markers to better identify those who are at increased risk. C-reactive protein (CRP) is found in endothelial atherosclerotic lesions, and evidence suggests that it may play a role in atherogenesis. Of candidate serum markers that might add information to clinical risk assessment, high-sensitivity C-reactive protein (hsCRP) measurement has the most potential for clinical use for multiple reasons: (a) high hsCRP is associated with a twofold to a threefold increase in the prevalence of myocardial infarction, stroke, and peripheral vascular disease, and it predicts incident cardiovascular events in those with and without preexisting CVD; (b) the increased risk associated with high hsCRP is independent of other established risk factors; (c) hsCRP augments the predictive capacity of the Framingham Risk Score; (d) hsCRP assays are standardized, and this analyte is biologically stable over time; (e) various risk-reducing interventions also reduce hsCRP, and research is underway to assess whether specifically targeting hsCRP reduces CVD risk. National guidelines regarding the clinical utility of hsCRP in primary and secondary prevention settings have been recently issued.
心血管疾病（CVD）病因是多因素的。传统的心血管危险因素，如胆固醇浓度升高和血压升高，被用于评估CVD风险。最近，对炎症在动脉粥样硬化中作用的更深入了解促使许多人提议测量各种炎症标志物，以更好地识别那些风险增加的人。C反应蛋白（CRP）存在于内皮动脉粥样硬化病变中，有证据表明它可能在动脉粥样硬化形成中起作用。在可能为临床风险评估增添信息的候选血清标志物中，高敏C反应蛋白（hsCRP）测量因多种原因最具临床应用潜力：（a）高hsCRP与心肌梗死、中风和外周血管疾病患病率增加两倍至三倍相关，并且它可预测有无CVD既往史者发生心血管事件；（b）与高hsCRP相关的风险增加独立于其他已确定的危险因素；（c）hsCRP增强了弗明汉姆风险评分的预测能力；（d）hsCRP检测是标准化的，并且这种分析物在一段时间内生物学性质稳定；（e）各种降低风险的干预措施也会降低hsCRP，并且正在进行研究以评估专门针对hsCRP是否能降低CVD风险。最近已发布了关于hsCRP在一级和二级预防环境中临床应用的国家指南。
