Imai Koichiro, Okura Hiroyuki, Kume Teruyoshi, Yamada Ryotaro, Miyamoto Yoshinori, Kawamoto Takahiro, Watanabe Nozomi, Neishi Yoji, Toyota Eiji, Yoshida Kiyoshi
Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan.
Am Heart J. 2008 Oct;156(4):713-8. doi: 10.1016/j.ahj.2008.04.011. Epub 2008 Sep 9.
C-Reactive protein (CRP) has been shown to play a pivotal role in the pathogenesis of atherosclerosis progression. The aim of this study was to assess whether CRP predicts severity, progression, and prognosis of aortic valve stenosis (AS).
One hundred and thirty-five patients with asymptomatic AS were studied. Patients were diagnosed as mild (n = 18, aortic valve area [AVA] > or =1.5 cm(2)), moderate (n = 57, AVA 1.0-1.49 cm(2)), or severe AS (n = 60, AVA <1.0 cm(2)) by Doppler echocardiography. Patients with serial (baseline and at 1 year) echocardiographic examination (n = 47) were grouped as either slow (n = 22, DeltaAVA <-0.15 cm(2)/y) or rapid progression group (n = 25, DeltaAVA > or =-0.15 cm(2)/y). In addition, long-term prognosis was compared between patients with low CRP (n = 68, CRP <0.15 mg/dL) and those with high CRP (n = 67, CRP > or =0.15 mg/dL).
Baseline CRP was significantly higher in patients with severe AS than in those with mild or moderate AS (mild AS 0.17 +/- 0.43, moderate AS 0.22 +/- 0.28, severe AS 0.53 +/- 0.66 mg/dL, P = .001). By multivariate logistic regression analysis, CRP was an independent predictor of severe AS (odds ratio 3.51, P = .015). Similarly, CRP was significantly higher in the rapid progression group than in the slow progression group (0.56 +/- 0.76 vs 0.19 +/- 0.25 mg/dL, P = .004). Furthermore, long-term survival was significantly lower in the high CRP group than in the low CRP group (log rank: P < .001).
C-Reactive protein predicts severity, progression, and prognosis in patients with asymptomatic AS.
C反应蛋白（CRP）已被证明在动脉粥样硬化进展的发病机制中起关键作用。本研究的目的是评估CRP是否可预测主动脉瓣狭窄（AS）的严重程度、进展及预后。
对135例无症状AS患者进行研究。通过多普勒超声心动图将患者诊断为轻度（n = 18，主动脉瓣面积[AVA]≥1.5 cm²）、中度（n = 57，AVA 1.0 - 1.49 cm²）或重度AS（n = 60，AVA＜1.0 cm²）。对进行了系列（基线和1年时）超声心动图检查的患者（n = 47）分为进展缓慢组（n = 22，AVA变化量[ΔAVA]＜ - 0.15 cm²/年）或进展快速组（n = 25，ΔAVA≥ - 0.15 cm²/年）。此外，比较了低CRP患者（n = 68，CRP＜0.15 mg/dL）和高CRP患者（n = 67，CRP≥0.15 mg/dL）的长期预后。
重度AS患者的基线CRP显著高于轻度或中度AS患者（轻度AS 0.17±0.43，中度AS 0.22±0.28，重度AS 0.53±0.66 mg/dL，P = 0.001）。通过多因素逻辑回归分析，CRP是重度AS的独立预测因子（比值比3.51，P = 0.015）。同样，进展快速组的CRP显著高于进展缓慢组（0.56±0.76 vs 0.19±0.25 mg/dL，P = 0.004）。此外，高CRP组的长期生存率显著低于低CRP组（对数秩检验：P＜0.001）。
C反应蛋白可预测无症状AS患者的严重程度、进展及预后。
