Brodov Yafim, Behar Shlomo, Goldenberg Ilan, Boyko Valentina, Chouraqui Pierre
Heart Institute, Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Cardiol. 2009 Jul 15;104(2):194-8. doi: 10.1016/j.amjcard.2009.03.017. Epub 2009 May 4.
Combined assessment of serum uric acid (UA) and C-reactive protein (CRP) compared with single-marker evaluation in patients with coronary artery disease (CAD) was performed. CRP is an independent predictor of cardiac events in patients with or without CAD. Data regarding the prognostic value of UA in patients with CAD are conflicting. The primary end point (fatal or nonfatal myocardial infarction or sudden cardiac death) was related to levels of UA and CRP in 2,966 patients with CAD enrolled in the Bezafibrate Infarction Prevention trial who were followed for a mean period of 6.2 years. Primary end-point rates were directly related to increasing tertiles (from tertile 1 [T1] to tertile 3 [T3]) of UA (12.7%, 12.8%, and 17.6% respectively, p for trend <0.0001) and CRP (11.5%, 14.2%, and 17.3% respectively, p for trend <0.002). By multivariable analysis, T3 UA (>6.25 mg/dl) and T3 CRP (>5.37 mg/dl) were shown to be independently associated with a significant increase in risk for the primary end point (hazard ratio 1.30, 1.01 to 1.68, p = 0.04; hazard ratio 1.31, 1.02 to 1.69, p = 0.03, respectively). Primary end-point rates were similarly high in those patients with a combination of T3 UA and T1 CRP levels (hazard ratio 1.68, 1.05 to 2.66) or a combination of T3 CRP and T1 serum UA levels (hazard ratio 1.64, 1.04 to 2.58) or in patients with T3 of the 2 markers (hazard ratio 1.66, 1.07 to 2.59). In conclusion, combined assessment of UA and CRP levels provides incremental information for risk stratification of patients with CAD with low levels of a single marker.
对冠状动脉疾病（CAD）患者进行了血清尿酸（UA）和C反应蛋白（CRP）联合评估，并与单一标志物评估进行比较。CRP是有无CAD患者心脏事件的独立预测指标。关于UA在CAD患者中的预后价值的数据存在冲突。在苯扎贝特预防心肌梗死试验中纳入的2966例CAD患者中，主要终点（致命或非致命心肌梗死或心源性猝死）与UA和CRP水平相关，这些患者平均随访6.2年。主要终点发生率与UA的三分位数增加（从三分位数1 [T1]到三分位数3 [T3]）直接相关（分别为12.7%、12.8%和17.6%，趋势p<0.0001），与CRP的三分位数增加也直接相关（分别为11.5%、14.2%和17.3%，趋势p<0.002）。通过多变量分析，T3 UA（>6.25mg/dl）和T3 CRP（>5.37mg/dl）与主要终点风险显著增加独立相关（风险比分别为1.30，95%置信区间1.01至1.68，p = 0.04；风险比1.31，95%置信区间1.02至1.69，p = 0.03）。在T3 UA和T1 CRP水平组合的患者（风险比1.68，95%置信区间1.05至2.66）或T3 CRP和T1血清UA水平组合的患者（风险比1.64，95%置信区间1.04至2.58）或两种标志物均为T3的患者中，主要终点发生率同样较高（风险比1.66，95%置信区间1.07至2.59）。总之，UA和CRP水平的联合评估为单一标志物水平较低的CAD患者的风险分层提供了额外信息。
