根据高敏 C 反应蛋白浓度，高和极高心血管风险患者的高甘油三酯血症的预后意义。
Prognostic Significance of Hypertriglyceridemia in Patients at High and Very High Cardiovascular Risk Depending on the Concentration of Highsensitivity C-reactive Protein.
机构信息
Department of Internal Medicine, South-Ural State Medical University, Chelyabinsk, Russia.
Department of Hospital Therapy, South-Ural State Medical University, Chelyabinsk, Russia.
出版信息
Endocr Metab Immune Disord Drug Targets. 2022;22(14):1403-1409. doi: 10.2174/1871530322666220427094330.
BACKGROUND
It has been established that an increase in triglyceride-rich lipoprotein levels is associated with the development of systemic low-grade inflammation. Data on the prognostic role of hypertriglyceridemia (HTG) dependent on the state of low-grade inflammation are limited.
OBJECTIVE
The study's objective was to evaluate the predictive value of mild-to-moderate HTG (2.3- 11.2 mmol/L) regarding the development of cardiovascular events in patients at high and very high cardiovascular risk (CVR), depending on the high-sensitivity C-reactive protein (hsCRP) values.
METHODS
The study included 185 patients with high and very high CVR. The concentration of hsCRP in blood serum was measured using an enzyme-linked immunosorbent assay kit. The combined endpoint was cardiovascular death, nonfatal myocardial infarction or unstable angina (which required hospitalization), nonfatal stroke, and coronary revascularization.
RESULTS
HTG was revealed in 17.3% of the patients. An increase in hsCRP ≥2.0 mg/L was observed in 51.9% of the patients. The event-free survival of patients with HTG was not statistically different from that in patients with TG <2.3 mmol/L (RR 1.61; 95% CI 0.86-3.00; p=0.133). In the subgroup of patients with hsCRP <2.0 mg/L, patients with HTG were not significantly different from patients without HTG. In the subgroup of patients with hsCRP≥2.0 mg/L, the presence of HTG was associated with a 4.63 times increase in the RR of adverse cardiovascular events (95% CI 1.35-15.8; p=0.015) after adjusting for potential confounders.
CONCLUSION
In patients with high and very high CVR, an increase in TG ≥2.3 mmol/L was associated with the development of adverse cardiovascular events only in the subgroup of patients with an increase in hsCRP ≥2.0 mg/L. The presence of HTG was associated with a 4.63 times increase in RR of adverse cardiovascular events (95% CI 1.35-15.8; p=0.015).
背景
已经证实，甘油三酯丰富的脂蛋白水平的增加与全身低度炎症的发展有关。关于依赖低度炎症状态的高甘油三酯血症（HTG）的预后作用的数据是有限的。
目的
本研究的目的是评估轻中度 HTG（2.3-11.2mmol/L）对高和极高心血管风险（CVR）患者发生心血管事件的预测价值，取决于高敏 C 反应蛋白（hsCRP）值。
方法
该研究纳入了 185 名高和极高 CVR 的患者。使用酶联免疫吸附测定试剂盒测量血清中 hsCRP 的浓度。复合终点为心血管死亡、非致死性心肌梗死或不稳定型心绞痛（需要住院治疗）、非致死性卒中以及冠状动脉血运重建。
结果
17.3%的患者存在 HTG。51.9%的患者 hsCRP 升高≥2.0mg/L。HTG 患者的无事件生存率与 TG<2.3mmol/L 的患者无统计学差异（RR 1.61；95%CI 0.86-3.00；p=0.133）。在 hsCRP<2.0mg/L 的患者亚组中，HTG 患者与无 HTG 患者无显著差异。在 hsCRP≥2.0mg/L 的患者亚组中，HTG 的存在与不良心血管事件 RR 增加 4.63 倍相关（95%CI 1.35-15.8；p=0.015），调整了潜在混杂因素后。
结论
在高和极高 CVR 的患者中，TG 升高≥2.3mmol/L 仅与 hsCRP 升高≥2.0mg/L 的患者亚组发生不良心血管事件相关。HTG 的存在与不良心血管事件 RR 增加 4.63 倍相关（95%CI 1.35-15.8；p=0.015）。
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