Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark.
Int J Cardiol. 2012 Oct 4;160(2):89-94. doi: 10.1016/j.ijcard.2011.03.030. Epub 2011 Apr 3.
Elevated levels of inflammatory mediators reflect vascular inflammation, and play a significant role in the genesis of atherosclerosis, plaque instability and rupture.
Plasma α-defensin and serum high sensitivity C reactive protein (hs-CRP) levels were examined in 463 patients with lower-extremity peripheral arterial disease (PAD). The relationships between inflammatory markers and lethal outcome were examined by Cox regression, and receiver operating characteristic (ROC) analysis.
Overall, 126 patients died, hereof 59 of cardiovascular causes. The patients with chronic critical limb ischemia (CLI) at baseline had significantly higher α-defensin and hs-CRP levels compared with patients with intermittent claudication (IC). For patients with IC, the relative risk for cardiovascular mortality was three times higher in patients within the upper tertile of α-defensin concentration (>162 μg/l), when compared with those in the two lower tertiles (HR 3.04 95% CI 1.26-7.32). The multivariable model revealed that IC-patients with high α-defensin and high hs-CRP concentration had more than 5 times higher risk for cardiovascular mortality than those with either high α-defensin or high hs-CRP alone, and low α-defensin or low hs-CRP concentrations (HR 5.16, 95% CI 1.78-14.8). Area under the ROC curve for combined use of high values of α-defensin and hs-CRP was 0.71 (95% CI 0.57-0.85). The addition of α-defensin or hs-CRP to conventional risk factors significantly improved the accuracy of risk prediction model for cardiovascular mortality. No associations were found among α-defensin, hs-CRP, and lethal outcome for patients with CLI.
Combined analysis of α-defensin and hs-CRP, adds prognostic information with regard to the long-term cardiovascular prognosis among patients with IC.
炎症介质水平升高反映了血管炎症，并在动脉粥样硬化、斑块不稳定和破裂的发生中起重要作用。
在 463 例下肢外周动脉疾病（PAD）患者中检测了血浆α-防御素和血清高敏 C 反应蛋白（hs-CRP）水平。通过 Cox 回归和受试者工作特征（ROC）分析，研究了炎症标志物与致死结局之间的关系。
共有 126 例患者死亡，其中 59 例死于心血管原因。与间歇性跛行（IC）患者相比，基线时患有慢性严重肢体缺血（CLI）的患者α-防御素和 hs-CRP 水平明显升高。对于 IC 患者，与两个低三分位组相比，α-防御素浓度上三分位（>162μg/l）的患者心血管死亡率的相对风险高 3 倍（HR 3.04，95%CI 1.26-7.32）。多变量模型显示，高α-防御素和高 hs-CRP 浓度的 IC 患者的心血管死亡率风险比仅高α-防御素或高 hs-CRP 的患者高 5 倍以上，且低α-防御素或低 hs-CRP 浓度的患者高 5 倍以上（HR 5.16，95%CI 1.78-14.8）。联合使用高值α-防御素和 hs-CRP 的 ROC 曲线下面积为 0.71（95%CI 0.57-0.85）。将α-防御素或 hs-CRP 加入常规危险因素可显著提高心血管死亡率风险预测模型的准确性。CLI 患者的α-防御素、hs-CRP 与致死结局之间无相关性。
α-防御素和 hs-CRP 的联合分析为 IC 患者的长期心血管预后提供了预后信息。
