无症状患者 C 反应蛋白与冠状动脉斑块类型的相关性：冠状动脉 CT 血管造影评估。
Association between C-reactive Protein and type of coronary arterial plaque in asymptomatic patients: assessment with coronary CT angiography.
机构信息
From the Department of Radiology and Research Institute of Radiology (D.H.Y., J.W.K., T.H.L.), Health Screening and Promotion Center (H.K.K., J.C.), Department of Clinical Epidemiology and Biostatistics (S.B.), Department of Preventive Medicine (S.H.K.), and Department of Cardiology (G.M.P., Y.H.K.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea; Department of Radiology, Gangnam Severance Hospital, University of Yonsei, Seoul, South Korea (T.H.K.); and Center for Optoelectronic Biomedicine and Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (W.Y.I.T.).
出版信息
Radiology. 2014 Sep;272(3):665-73. doi: 10.1148/radiol.14130772. Epub 2014 Apr 3.
PURPOSE
To determine whether C-reactive protein is associated with the type of coronary plaque seen at computed tomographic (CT) angiography.
MATERIALS AND METHODS
The institutional review board approved this retrospective study, and the need for informed consent was waived. C-reactive protein levels were measured in 2653 asymptomatic subjects (mean age ± standard deviation, 54.7 years ± 9.2; 1811 men) who underwent self-referred coronary CT angiography as part of a general health checkup. The presence of coronary plaque, plaque type (calcified, mixed calcified, or noncalcified), stenosis degree, and number of involved segments were evaluated. Subjects with one type of plaque (calcified plaque, mixed plaque, and noncalcified plaque groups) and two or more types of plaque (multiple lesions group) were analyzed separately. Multivariate logistic regression analysis was used to evaluate the association between increasing C-reactive protein levels and plaque type.
RESULTS
Coronary plaque was found in 1150 of the 2653 subjects (43.3%): calcified plaque (n = 604, 22.8%), mixed plaque (n = 67, 2.5%), noncalcified plaque (n = 208, 7.8%), and multiple lesions (n = 271, 10.2%). The C-reactive protein cutoff value of the fourth quartile was 1.2 mg/L (11.4 nmol/L), and all types of coronary plaque were increased in the higher quartile of the C-reactive protein levels. Multivariate logistic regression analysis showed that a higher C-reactive protein level was an independent predictor for the presence of noncalcified plaque (fourth vs first quartile group, odds ratio = 1.70, P = .025) and significant (50% and higher) coronary stenosis (odds ratio = 1.76, P = .020) after adjustment for traditional risk factors for coronary artery disease.
CONCLUSION
C-reactive protein is associated with noncalcified coronary arterial plaque, as seen at coronary CT angiography in asymptomatic patients after adjustment for traditional risk factors.
目的
确定 C 反应蛋白（C-reactive protein，CRP）与计算机断层扫描（CT）血管造影中所见的冠状动脉斑块类型是否相关。
材料与方法
本回顾性研究经机构审查委员会批准，且豁免了知情同意书的要求。在一项常规健康体检中，对 2653 例无症状受试者（平均年龄±标准差，54.7 岁±9.2；1811 例男性）进行了 CRP 水平检测，这些受试者自愿接受了冠状动脉 CT 血管造影检查。评估了冠状动脉斑块的存在、斑块类型（钙化斑块、混合性钙化斑块或非钙化斑块）、狭窄程度和受累节段数量。将存在一种类型斑块（钙化斑块组、混合斑块组和非钙化斑块组）和两种或两种以上类型斑块（多病灶组）的受试者分别进行分析。采用多变量逻辑回归分析评估 CRP 水平升高与斑块类型之间的关系。
结果
在 2653 例受试者中，1150 例（43.3%）发现有冠状动脉斑块：钙化斑块（n=604 例，22.8%）、混合性钙化斑块（n=67 例，2.5%）、非钙化斑块（n=208 例，7.8%）和多病灶（n=271 例，10.2%）。第四四分位 CRP 截断值为 1.2mg/L（11.4nmol/L），且 CRP 水平较高四分位组的所有类型冠状动脉斑块均增加。多变量逻辑回归分析显示，CRP 水平较高是存在非钙化斑块（第四四分位组与第一四分位组相比，比值比=1.70，P=0.025）和显著（≥50%）冠状动脉狭窄（比值比=1.76，P=0.020）的独立预测因素，校正冠状动脉疾病的传统危险因素后。
结论
在调整了传统的冠状动脉疾病危险因素后，CRP 与无症状患者冠状动脉 CT 血管造影中所见的非钙化性冠状动脉斑块有关。
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