Iwashima Yoshio, Horio Takeshi, Kamide Kei, Rakugi Hiromi, Ogihara Toshio, Kawano Yuhei
Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Hypertens Res. 2007 Dec;30(12):1177-85. doi: 10.1291/hypres.30.1177.
We examined the association between C-reactive protein (CRP) and left ventricular mass index (LVMI), and investigated prospectively the incidence of cardiovascular disease (CVD) in asymptomatic subjects with essential hypertension. A total of 629 subjects (mean age 62 years, 51% female) free of prior CVD were included in this study. In cross-sectional analysis at baseline, patients were divided into three groups according to serum CRP levels: <1, 1 to 2, and >2 mg/L. In multivariate analysis, LVMI increased in a stepwise fashion with increasing CRP levels in both men (127.2+/-2.9, 138.7+/-4.1, 141.8+/-3.5 g/m(2), respectively; F=6.85, p=0.001) and women (119.5+/-3.6, 129.2+/-4.9, 130.2+/-4.8 g/m(2); F=4.23, p=0.031). During follow-up (mean 32 months), 52 subjects (19 female) developed CVD. Kaplan-Meier analysis with log-rank tests showed a significantly poorer event-free survival rate in the group with elevated CRP levels (> or =1 mg/L) (chi(2)=8.22, p<0.01) and that with left ventricular hypertrophy (LVH) (chi(2)=19.91, p<0.01). When participants were divided into four groups on the basis of CRP level (<1 or > or =1 mg/L) and the absence or presence of LVH, the group with LVH/CRP> or =1 mg/L showed markedly poorer event-free survival (chi(2)=28.02, p<0.01), and the adjusted hazard ratio by multivariate Cox regression analysis was 2.65 (95% confidence interval [CI]=1.55-5.46, p<0.01). In the subgroup with LVH (n=362), a significantly lower event-free survival rate of CVD was also observed in the group with CRP> or =1 mg/L (hazard ratio [HR] 1.37, 95% CI: 1.02-1.85, p=0.025). Our findings demonstrate that the CRP level is independently associated with LVMI, and suggest that measurement of CRP may provide clinically important prognostic information to supplement LVH.
我们研究了C反应蛋白（CRP）与左心室质量指数（LVMI）之间的关联，并前瞻性地调查了无症状原发性高血压患者的心血管疾病（CVD）发病率。本研究共纳入629例无既往CVD的受试者（平均年龄62岁，51%为女性）。在基线横断面分析中，根据血清CRP水平将患者分为三组：<1、1至2和>2 mg/L。多变量分析显示，男性（分别为127.2±2.9、138.7±4.1、141.8±3.5 g/m²；F=6.85，p=0.001）和女性（119.5±3.6、129.2±4.9、130.2±4.8 g/m²；F=4.23，p=0.031）的LVMI均随CRP水平升高呈逐步上升趋势。随访期间（平均32个月），52例受试者（19例女性）发生了CVD。采用对数秩检验的Kaplan-Meier分析显示，CRP水平升高（≥1 mg/L）组（χ²=8.22，p<0.01）和左心室肥厚（LVH）组（χ²=19.91，p<0.01）的无事件生存率显著较低。当根据CRP水平（<1或≥1 mg/L）以及是否存在LVH将参与者分为四组时，LVH/CRP≥1 mg/L组的无事件生存率明显较低（χ²=28.02，p<0.01），多变量Cox回归分析调整后的风险比为2.65（95%置信区间[CI]=1.55-5.46，p<0.01）。在LVH亚组（n=362）中，CRP≥1 mg/L组的CVD无事件生存率也显著较低（风险比[HR] 1.37，95% CI：1.02-1.85，p=0.025）。我们的研究结果表明，CRP水平与LVMI独立相关，并提示检测CRP可能为补充LVH提供重要的临床预后信息。
