[高敏C反应蛋白的哪个临界值对于确定急性冠状动脉综合征患者的长期预后更有价值？]

[Which cut-off value of high sensitivity C- reactive protein is more valuable for determining long- term prognosis in patients with acute coronary syndrome?].

作者信息

Kiliç Teoman, Ural Ertan, Oner Gökhan, Sahin Tayfun, Kiliç Metehan, Yavuz Sadan, Kanko Muhip, Kahraman Göksel, Bildirici Ulaş, Berki Kamil Turan, Ural Dilek

机构信息

Kocaeli Universitesi Tip Fakültesi, Kardiyoloji Anabilim Dali, Girişimsel Kardiyoloji Araştirma ve Uygulama Birimi, Kocaeli, Türkiye.

出版信息

Anadolu Kardiyol Derg. 2009 Aug;9(4):280-9.

PMID:19666429

Abstract

OBJECTIVE

The aim of this study to investigate prognostic efficacy of high sensitivity C-reactive protein (hs-CRP) in patients with acute coronary syndrome (ACS) and to identify the most valuable cut-off value of hs-CRP for determining long term prognosis.

METHODS

A total of 240 ACS patients presenting within 6 h after the onset of chest pain were included to the study. Admission levels of hs-CRP were analyzed. Patients were followed for 1 year. Primary end-point of the study was new coronary event (NCE), defined as the combination of cardiac death, nonfatal myocardial infarction and recurrent rest angina. Risk factors for NCE were determined by logistic regression analysis. ROC-curve analysis was used to identify cut-off values of the risk factors. The prognostic efficacy of the cut-off value of hs-CRP was compared to other values determined from other studies. Kaplan Meier and log rank tests were used in survival analyses. Factors determining event-free survival were investigated by Cox regression analysis.

RESULTS

During the follow-up period, 65 NCEs occurred. In multivariate analysis, hs-CRP was strongly associated with the occurrence of NCE (OR=4.79, 95% CI=2.10-10.44, p<0.001). Cut-off value of hs-CRP for NCE was 1.1 mg/dl (AUC=0.68, 95% CI=0.62-0.74, p<0.001). Compared to other values of different studies, hs-CRP>1.1 mg/dl had the optimal positive and negative predictive values. In the Cox regression analysis, hs-CRP was emerged as the most important parameter for determining event-free survival (RR=3.44, 95% CI=1.91-6.21, p<0.001).

CONCLUSION

Admission levels of hs-CRP were emerged as the most important parameter for prognosis and the cut-off value of hs-CRP for predicting NCE was found as 1.1 mg/dl in this cohort of the study population. Further studies are required to confirm the most risky cut off value of hs-CRP for predicting long term prognosis among ACS patients and in general population.

摘要

目的

本研究旨在探讨高敏C反应蛋白（hs-CRP）对急性冠状动脉综合征（ACS）患者的预后评估价值，并确定用于判断长期预后的hs-CRP最具价值的临界值。

方法

共纳入240例胸痛发作6小时内就诊的ACS患者，分析其入院时hs-CRP水平。对患者进行1年随访。研究的主要终点是新发冠状动脉事件（NCE），定义为心源性死亡、非致死性心肌梗死和复发性静息性心绞痛的组合。通过逻辑回归分析确定NCE的危险因素。采用ROC曲线分析确定危险因素的临界值。将hs-CRP临界值的预后评估价值与其他研究确定的值进行比较。生存分析采用Kaplan Meier法和对数秩检验。通过Cox回归分析研究决定无事件生存的因素。

结果

随访期间发生65例NCE。多因素分析显示，hs-CRP与NCE的发生密切相关（OR = 4.79，95%CI = 2.10 - 10.44，p < 0.001）。NCE的hs-CRP临界值为1.1mg/dl（AUC = 0.68，95%CI = 0.62 - 0.74，p < 0.001）。与不同研究的其他值相比，hs-CRP>1.1mg/dl具有最佳的阳性和阴性预测价值。在Cox回归分析中，hs-CRP是决定无事件生存的最重要参数（RR = 3.44，95%CI = 1.91 - 6.21，p < 0.001）。