Quarck Rozenn, Nawrot Tim, Meyns Bart, Delcroix Marion
Center for Pulmonary Vascular Diseases, Pneumology Department, Katholieke Universiteit Leuven, Leuven, Belgium.
J Am Coll Cardiol. 2009 Apr 7;53(14):1211-8. doi: 10.1016/j.jacc.2008.12.038.
Our aim was to investigate in a prospective study a potential role of C-reactive protein (CRP) in predicting the outcome in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).
CRP is a well-known marker of inflammation and tissue damage, widely recognized as a risk predictor of cardiovascular and coronary heart diseases.
Plasma levels of CRP have been measured in consecutive patients diagnosed with PAH and CTEPH, at the time of right heart catheterization.
Circulating CRP levels were increased in CTEPH and PAH patients compared with those in control subjects (4.9 mg l(-1), 95% confidence interval [CI]: 3.9 to 6.2 mg l(-1); 4.4 mg l(-1), 95% CI: 3.5 to 5.4 mg l(-1); and 2.3 mg l(-1), 95% CI: 1.9 to 2.7 mg l(-1), respectively; p < 0.0001). In PAH patients, CRP levels correlated with New York Heart Association functional class (r = 0.23), right atrial pressure (r = 0.25), and 6-min walking distance (r = -0.19) and were significantly higher in nonsurvivors than in survivors (p = 0.003). All PAH, idiopathic PAH, and patients naive for disease-specific medication with CRP levels >5.0 mg l(-1) had a significantly lower survival rate (p = 0.02, p = 0.009, and p < 0.05, respectively). In CTEPH patients, circulating CRP levels significantly decreased 12 months after pulmonary endarterectomy (n = 23, 4.0 mg l(-1), 95% CI: 2.8 to 5.8 mg l(-1), to 1.6 mg l(-1), 95% CI: 2.2 to 3.0 mg l(-1); p = 0.004). PAH patients normalizing their CRP levels under treatment (n = 29), assigned as responders, had a significantly higher survival rate (p < 0.05). The proportion of patients treated with a parenteral prostacyclin-analogue was significantly higher among the responders than the nonresponders (55% vs. 17%, p = 0.002).
This is the first evidence of a role of an inflammatory marker, such as CRP, in predicting outcome and response to therapy in PAH.
我们旨在通过一项前瞻性研究，探讨C反应蛋白（CRP）在预测肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）预后方面的潜在作用。
CRP是一种众所周知的炎症和组织损伤标志物，被广泛认为是心血管疾病和冠心病的风险预测指标。
在连续诊断为PAH和CTEPH的患者进行右心导管检查时，检测其血浆CRP水平。
与对照组相比，CTEPH和PAH患者的循环CRP水平升高（分别为4.9 mg l⁻¹，95%置信区间[CI]：3.9至6.2 mg l⁻¹；4.4 mg l⁻¹，95%CI：3.5至5.4 mg l⁻¹；以及2.3 mg l⁻¹，95%CI：1.9至2.7 mg l⁻¹；p<0.0001）。在PAH患者中，CRP水平与纽约心脏协会功能分级（r = 0.23）、右心房压力（r = 0.25）和6分钟步行距离（r = -0.19）相关，且非幸存者的CRP水平显著高于幸存者（p = 0.003）。所有PAH、特发性PAH以及未接受过疾病特异性药物治疗且CRP水平>5.0 mg l⁻¹的患者生存率显著较低（分别为p = 0.02、p = 0.009和p<0.05）。在CTEPH患者中，肺血栓内膜剥脱术后12个月，循环CRP水平显著下降（n = 23，从4.0 mg l⁻¹，95%CI：2.8至5.8 mg l⁻¹降至1.6 mg l⁻¹，95%CI：2.2至3.0 mg l⁻¹；p = 0.004）。在治疗过程中CRP水平恢复正常的PAH患者（n = 29），被认定为反应者，其生存率显著更高（p<0.05）。反应者中接受肠外前列环素类似物治疗的患者比例显著高于无反应者（55%对17%，p = 0.002）。
这是首次有证据表明炎症标志物如CRP在预测PAH的预后和治疗反应中发挥作用。
