Nozaki Toshimitsu, Sugiyama Seigo, Koga Hidenobu, Sugamura Koichi, Ohba Keisuke, Matsuzawa Yasushi, Sumida Hitoshi, Matsui Kunihiko, Jinnouchi Hideaki, Ogawa Hisao
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
J Am Coll Cardiol. 2009 Aug 11;54(7):601-8. doi: 10.1016/j.jacc.2009.05.022.
We investigated whether a multiple biomarkers strategy that includes plasma levels of endothelium-derived microparticles (EMP), reflecting endothelial dysfunction, can improve prediction of future cardiovascular events in patients at high risk for coronary heart disease (CHD).
Detailed risk stratification using multiple biomarkers can provide clinical benefits in high-risk patients. Endothelial dysfunction has been described as a predictor of cardiovascular complications.
We measured 3 biomarkers in 488 consecutive patients with various CHD risks: B-type natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), and EMP. We followed 387 stable patients at high risk for CHD and examined future cardiovascular events.
During a mean follow-up of 36 months, 55 patients developed cardiovascular events. Multivariate Cox proportional hazards analysis adjusted for established risk factors identified age, BNP, hsCRP, and EMP as significant and independent predictors of future cardiovascular events (age: hazard ratio [HR]: 1.042, 95% confidence interval [CI]: 1.007 to 1.080, p = 0.02; BNP: HR: 1.242, 95% CI: 1.004 to 1.536, p = 0.046; hsCRP: HR: 1.468, 95% CI: 1.150 to 1.875, p = 0.002; EMP: HR: 1.345, 95% CI: 1.094 to 1.652, p = 0.005). The C statistics for cardiovascular events increased when each biomarker or combinations of biomarkers were added to the Framingham risk model (C statistics: Framingham risk model alone 0.636, Framingham risk + BNP 0.695, Framingham risk + hsCRP 0.696, Framingham risk + EMP 0.682, and Framingham risk + BNP + hsCRP + EMP 0.763).
The assessment of endothelial dysfunction by plasma levels of EMP can independently predict future cardiovascular events in patients at high risk for CHD. A multiple biomarkers strategy that includes endothelial dysfunction assessed by EMP can identify patients vulnerable to cardiovascular disease. (University Hospital Medical Information Network number: UMIN000000876).
我们研究了一种包括反映内皮功能障碍的血浆内皮源性微粒（EMP）水平的多重生物标志物策略，是否能够改善对冠心病（CHD）高危患者未来心血管事件的预测。
使用多重生物标志物进行详细的风险分层可为高危患者带来临床益处。内皮功能障碍已被描述为心血管并发症的预测指标。
我们对488例具有不同CHD风险的连续患者测量了3种生物标志物：B型利钠肽（BNP）、高敏C反应蛋白（hsCRP）和EMP。我们对387例CHD高危稳定患者进行随访，并检查未来心血管事件。
在平均36个月的随访期间，55例患者发生了心血管事件。对已确定的风险因素进行调整的多变量Cox比例风险分析确定年龄、BNP、hsCRP和EMP是未来心血管事件的显著且独立的预测因素（年龄：风险比[HR]：1.042，95%置信区间[CI]：1.007至1.080，p = 0.02；BNP：HR：1.242，95%CI：1.004至1.536，p = 0.046；hsCRP：HR：1.468，95%CI：1.150至1.875，p = 0.002；EMP：HR：1.345，95%CI：1.094至1.652，p = 0.005）。当将每种生物标志物或生物标志物组合添加到弗雷明汉风险模型中时，心血管事件的C统计量增加（C统计量：仅弗雷明汉风险模型为0.636，弗雷明汉风险 + BNP为0.695，弗雷明汉风险 + hsCRP为0.696，弗雷明汉风险 + EMP为0.682，弗雷明汉风险 + BNP + hsCRP + EMP为0.763）。
通过血浆EMP水平评估内皮功能障碍可独立预测CHD高危患者未来的心血管事件。一种包括通过EMP评估内皮功能障碍的多重生物标志物策略可以识别易患心血管疾病的患者。（大学医院医学信息网络编号：UMIN000000876）
