Windram Jonathan D, Loh Puan H, Rigby Alan S, Hanning Ian, Clark Andrew L, Cleland John G F
Academic Cardiology Department, University of Hull, Hull Royal Infirmary Castle Hill Hospital, Hull, United Kingdom.
Am Heart J. 2007 Jun;153(6):1048-55. doi: 10.1016/j.ahj.2007.03.044.
Inflammatory markers are increased in chronic heart failure (CHF), including high-sensitivity C-reactive protein (hsCRP), but there is little information on its relationship to prognosis or other prognostic markers. We aimed to investigate the relationship between hsCRP and prognosis in patients with CHF and left ventricular systolic dysfunction (LVSD).
Patients with CHF and LVSD (n = 957), but without infection or inflammatory disease, were identified. Patients had their medical history taken, underwent physical examination, had electrocardiographic and echocardiographic assessment, and had a 6-minute corridor walk test (6MWT) and blood tests, including hsCRP and N-terminal pro-B natriuretic peptide (NT-pro-BNP).
Patients with worse New York Heart Association class (P = .02), shorter 6-minute corridor walk test distance (P < .001), higher NT-pro-BNP levels (P < .001), anemia (P < .001), and renal dysfunction (P < .001), but not lower LV ejection fraction, had higher plasma concentrations of hsCRP. Patients with a CRP of >11.0 pg/mL had a hazard ratio for death of 3.0 compared with those with a CRP of <2.8 pg/mL (P < .001). Of 402 patients who had a second sample taken for hsCRP at 1 year, 46% showed a substantial change from baseline levels. Marked increases in hsCRP were associated with a fall in hemoglobin level. NT-pro-BNP was noted to be a more accurate prognostic marker than hsCRP (area under the curve of 0.74 compared with 0.67 for hsCRP, P < .05).
Patients with CHF and LVSD have increased serum concentrations of hsCRP that are related to functional limitation and prognosis but not to the severity of LV ejection fraction.
慢性心力衰竭（CHF）患者体内的炎症标志物会升高，包括高敏C反应蛋白（hsCRP），但关于其与预后或其他预后标志物之间关系的信息较少。我们旨在研究CHF合并左心室收缩功能障碍（LVSD）患者中hsCRP与预后的关系。
确定了957例CHF合并LVSD患者，且这些患者无感染或炎症性疾病。收集患者病史，进行体格检查、心电图和超声心动图评估，以及6分钟走廊步行试验（6MWT）和血液检查，包括hsCRP和N末端B型利钠肽原（NT-pro-BNP）。
纽约心脏协会心功能分级较差（P = 0.02）、6分钟走廊步行试验距离较短（P < 0.001）、NT-pro-BNP水平较高（P < 0.001）、贫血（P < 0.001）和肾功能不全（P < 0.001）的患者，而非左心室射血分数较低的患者，其血浆hsCRP浓度较高。CRP>11.0 pg/mL的患者与CRP<2.8 pg/mL的患者相比，死亡风险比为3.0（P < 0.001）。在402例1年后再次采集hsCRP样本的患者中，46%的患者与基线水平有显著变化。hsCRP的显著升高与血红蛋白水平下降有关。NT-pro-BNP被认为是比hsCRP更准确的预后标志物（曲线下面积为0.74，而hsCRP为0.67，P < 0.05）。
CHF合并LVSD患者血清hsCRP浓度升高，这与功能受限和预后相关，但与左心室射血分数的严重程度无关。
