Department of Cardiology, University Hospital Ghent, Belgium.
Biomark Med. 2012 Feb;6(1):19-34. doi: 10.2217/bmm.11.108.
C-reactive protein (CRP), a pentraxin protein, is an established marker of acute phase reactions. There is some experimental evidence that the CRP molecule could be causative in all stages of atherosclerotic disease starting from endothelial dysfunction, continuing to plaque formation and destabilization, and to atherothrombotic complications. However, each claim of causality has elicited a counterpoint argument, and Mendelian randomization studies have confidently shown that the concentration of CRP is unlikely to be causative. Meta-analyses have attributed a 1.5-1.7-fold risk to one standard deviation increase of high-sensitive CRP (a high-sensitivity CRP assay) for major cardiovascular events after adjustments for classical risk factors. Additional adjustments for metabolic factors reduced the risk to approximately 1.2-1.4-fold, which is still significant. Of interest, high-sensitive CRP also predicted all-cause and cancer mortality. Driven by the JUPITER trial that showed a benefit on outcome for treatment with rosuvastatin in primary prevention, treatment has been recommended in patients with a moderate Framingham Risk Score with a high-sensitive CRP of >2 mg/l. However, adding CRP to risk charts and biomarker panels mostly yielded small and inconsistent improvements.
C 反应蛋白（CRP）是一种五聚素蛋白，是急性时相反应的既定标志物。有一些实验证据表明，CRP 分子可能在动脉粥样硬化疾病的所有阶段起作用，从内皮功能障碍开始，持续到斑块形成和不稳定，再到动脉粥样硬化血栓并发症。然而，每一个因果关系的主张都引发了一个反驳论点，孟德尔随机化研究有把握地表明，CRP 浓度不太可能是致病的。荟萃分析表明，在调整了经典风险因素后，高敏 CRP（高敏 CRP 检测）每增加一个标准差，主要心血管事件的风险增加 1.5-1.7 倍。进一步调整代谢因素后，风险降低到约 1.2-1.4 倍，仍然具有显著意义。有趣的是，高敏 CRP 还预测了全因和癌症死亡率。JUPITER 试验表明，在一级预防中使用瑞舒伐他汀治疗可改善预后，这一试验推动了治疗的开展，建议将中等弗雷明汉风险评分且高敏 CRP>2mg/L 的患者进行治疗。然而，将 CRP 添加到风险图表和生物标志物面板中，大多只产生了微小且不一致的改善。
