Krupinski Jerzy, Turu Marta M, Slevin Mark, Martínez-González José
Department of Neurology, Stroke Unit, Hospital Universitari de Bellvitge, Feixa Llarga s/n 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Curr Treat Options Cardiovasc Med. 2007 Jun;9(3):229-35. doi: 10.1007/s11936-007-0017-2.
Inflammation is receiving increased attention as a cause of atherosclerosis and stroke. Several inflammatory biomarkers, and particularly high-sensitivity C-reactive protein (hsCRP), have been identified as likely predictors of the risk of a future stroke. In clinical settings, it has been consistently observed that higher concentrations of CRP are associated with larger brain infarcts, stroke severity, neurologic disability, and future vascular events. However, there is still controversy over the degree of risk conferred by elevated CRP concentrations. Some studies reported that the predictive value of CRP is moderate compared with classical risk factors and is only weakly related to cardiovascular damage after adjustment for traditional cardiovascular risk factors. CRP like many other hemostatic factors is an acute-phase protein and, therefore, it is not always clear whether its association with cerebrovascular disease reflects its contribution to atherothrombosis, its acute-phase condition, or both. Furthermore, the value of single measurements of CRP in patients with concurrent infection or other inflammatory conditions has not been established and reported data should be interpreted cautiously. Several drugs, especially hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), have been demonstrated to reduce hsCRP levels independently of their effects on plasma cholesterol. Recently, emerging therapies have been aimed at the control of blood pressure and inflammation in stroke patients. Whether a reduction of hsCRP levels could be beneficial to stroke patients remains to be clarified, and it is also unclear whether other drugs may be useful to lower hsCRP levels. More studies are needed before hsCRP becomes a routine part of the evaluation of stroke patients. This should also prompt the search for new agents directly blocking CRP actions.
炎症作为动脉粥样硬化和中风的一个病因正受到越来越多的关注。几种炎症生物标志物，特别是高敏C反应蛋白（hsCRP），已被确定为未来中风风险的可能预测指标。在临床环境中，一直观察到较高浓度的CRP与更大的脑梗死、中风严重程度、神经功能障碍以及未来血管事件相关。然而，关于CRP浓度升高所带来的风险程度仍存在争议。一些研究报告称，与经典风险因素相比，CRP的预测价值中等，并且在调整传统心血管风险因素后，它与心血管损害的关联较弱。与许多其他止血因子一样，CRP是一种急性期蛋白，因此，其与脑血管疾病的关联究竟是反映了其对动脉粥样硬化血栓形成的作用、急性期状态，还是两者兼而有之，并不总是明确的。此外，在并发感染或其他炎症状态的患者中，单次测量CRP的价值尚未确定，对已报道数据的解读应谨慎。几种药物，特别是羟甲基戊二酰辅酶A还原酶抑制剂（他汀类药物），已被证明可独立于其对血浆胆固醇的作用降低hsCRP水平。最近，新出现的治疗方法旨在控制中风患者的血压和炎症。hsCRP水平降低是否对中风患者有益仍有待阐明，而且其他药物是否有助于降低hsCRP水平也不清楚。在hsCRP成为中风患者评估的常规部分之前，还需要更多的研究。这也应该促使人们寻找直接阻断CRP作用的新药物。
