高敏 C 反应蛋白对经皮冠状动脉介入治疗患者冠状动脉疾病严重程度和结局的影响。
Impact of high-sensitivity C-reactive protein on coronary artery disease severity and outcomes in patients undergoing percutaneous coronary intervention.
机构信息
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
出版信息
J Cardiol. 2020 Jan;75(1):60-65. doi: 10.1016/j.jjcc.2019.06.012. Epub 2019 Aug 13.
BACKGROUND
Inflammation plays a pivotal role in coronary artery disease (CAD). Few data from large-size studies are available on the association of high-sensitivity C-reactive protein (hs-CRP) and severity of CAD. Our aim was to investigate their relationship as well as their impact on long-term outcomes in patients undergoing percutaneous coronary intervention.
METHODS
In 2013, 10,020 patients were consecutively included. Patients were divided into three groups based on hs-CRP on admission: 0-3mg/L (n=6978, 69.6%), 3.01-10mg/L (n=1997, 19.9%), >10mg/L (n=1045, 10.4%). Disease severity was determined by SYNTAX score (SS). Their differences were assessed in SS and major adverse cardiovascular events (MACEs, including all-cause death, myocardial infarction, revascularization, and in-stent thrombosis) among groups.
RESULTS
The mean follow-up period was 874 days. Patients with elevated hs-CRP were older, had more risk factors such as hypertension, cerebrovascular disease, chronic obstructive pulmonary disease, and cigarette smoking. Multivariate regression analysis showed that hs-CRP >10mg/L (OR 1.49, 95% confidence interval 1.21-1.84, p<0.001), age, previous myocardial infarction, serum creatinine, and left ventricular ejection fraction were independent predictors of intermediate-high SS (>22). Subgroup analysis indicated that the relation between hs-CRP and SS was also consistent in acute coronary syndrome and its subtypes. Although elevated hs-CRP was positively associated with increased rates of MACEs (11.0% versus 12.1% versus 14.3%, p=0.006), death (1.0% versus 1.3% versus 3.0%, p<0.001), and revascularization (8.6% versus 10.4% versus 10.0%, p=0.032), it did not show any prognostic effect for adverse outcomes in multivariate regression analyses (all adjusted p> 0.05). While SS>22 remained independently predictive of MACEs and revascularization after adjusting confounders, the risks of which were increased by 56% and 68%, respectively.
CONCLUSION
Serum hs-CRP could be a useful biomarker for indicating CAD severity and could aid in risk stratification.
背景
炎症在冠状动脉疾病（CAD）中起着关键作用。目前关于高敏 C 反应蛋白（hs-CRP）与 CAD 严重程度之间的关联，仅有少量来自大规模研究的数据。我们的目的是探讨 hs-CRP 与长期预后的关系，以及它们在接受经皮冠状动脉介入治疗的患者中的影响。
方法
2013 年，连续纳入 10020 例患者。根据入院时 hs-CRP 将患者分为三组：0-3mg/L（n=6978，69.6%）、3.01-10mg/L（n=1997，19.9%）、>10mg/L（n=1045，10.4%）。通过 SYNTAX 评分（SS）确定疾病严重程度。评估三组间 SS 及主要不良心血管事件（MACE，包括全因死亡、心肌梗死、血运重建和支架内血栓形成）的差异。
结果
平均随访 874 天。hs-CRP 升高的患者年龄较大，有更多的危险因素，如高血压、脑血管疾病、慢性阻塞性肺疾病和吸烟。多变量回归分析显示，hs-CRP>10mg/L（OR 1.49，95%置信区间 1.21-1.84，p<0.001）、年龄、既往心肌梗死、血清肌酐和左心室射血分数是中间高 SS（>22）的独立预测因素。亚组分析表明，hs-CRP 与 SS 之间的关系在急性冠状动脉综合征及其亚型中也一致。虽然 hs-CRP 升高与 MACEs 发生率增加相关（11.0%比 12.1%比 14.3%，p=0.006）、死亡率（1.0%比 1.3%比 3.0%，p<0.001）和血运重建（8.6%比 10.4%比 10.0%，p=0.032），但多变量回归分析中，hs-CRP 对不良预后无预后作用（所有校正 p>0.05）。在校正混杂因素后，SS>22 仍然是 MACEs 和血运重建的独立预测因素，其风险分别增加了 56%和 68%。
结论
血清 hs-CRP 可作为一种有用的生物标志物，用于提示 CAD 严重程度，并有助于风险分层。
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