Singh T P, Morris D R, Smith S, Moxon J V, Golledge J
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia.
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia.
Eur J Vasc Endovasc Surg. 2017 Aug;54(2):220-233. doi: 10.1016/j.ejvs.2017.05.009. Epub 2017 Jun 27.
Patients with peripheral artery disease (PAD) are at substantial risk of cardiovascular events. There is interest in using blood markers, such as C-reactive protein (CRP), to monitor prognosis and treatment efficacy in PAD patients. The aim of this meta-analysis was to assess the association between CRP and major cardiovascular events in PAD patients.
Studies evaluating the association between CRP and major cardiovascular events (myocardial infarction, stroke, cardiac revascularisation and mortality) were identified using MEDLINE and the Cochrane library. Studies that did not include participants with PAD, measure CRP, or follow-up patients for cardiovascular events were excluded. Meta-analyses of published adjusted hazard ratios (HR) were conducted using an inverse variance-weighted random effects model, and heterogeneity was assessed with the I index.
A total of 16 studies involving 5041 participants met the inclusion criteria for the systematic review. Eight studies were included in the meta-analyses. Summary effect estimates were reported as HR comparing higher and lower quantiles, and HR per unit increase in logCRP. PAD patients with higher CRP had a significantly greater risk of major cardiovascular events compared with those with lower CRP (HR 2.26, 95% CI 1.65-3.09, p < 0.001). The HR for major cardiovascular events was 1.38 (95% CI 1.16-1.63, p < 0.001) per unit increase in logCRP.
The present findings suggest that high circulating CRP is predictive of major cardiovascular events in PAD patients.
外周动脉疾病（PAD）患者发生心血管事件的风险很高。人们有兴趣使用血液标志物，如C反应蛋白（CRP），来监测PAD患者的预后和治疗效果。本荟萃分析的目的是评估PAD患者中CRP与主要心血管事件之间的关联。
使用MEDLINE和Cochrane图书馆检索评估CRP与主要心血管事件（心肌梗死、中风、心脏血运重建和死亡率）之间关联的研究。排除未纳入PAD患者、未测量CRP或未对患者进行心血管事件随访的研究。使用逆方差加权随机效应模型对已发表的调整后风险比（HR）进行荟萃分析，并用I指数评估异质性。
共有16项涉及5041名参与者的研究符合系统评价的纳入标准。八项研究纳入了荟萃分析。汇总效应估计值报告为比较高低分位数的HR以及logCRP每增加一个单位的HR。与CRP水平较低的PAD患者相比，CRP水平较高的患者发生主要心血管事件的风险显著更高（HR 2.26，95%CI 1.65-3.09，p<0.001）。logCRP每增加一个单位，主要心血管事件的HR为1.38（95%CI 1.16-1.63，p<0.001）。
目前的研究结果表明，循环CRP水平升高可预测PAD患者发生主要心血管事件。
