Haverkate F, Thompson S G, Pyke S D, Gallimore J R, Pepys M B
Gaubius Laboratory TNO-PG, CE Leiden, Netherlands.
Lancet. 1997 Feb 15;349(9050):462-6. doi: 10.1016/s0140-6736(96)07591-5.
Inflammation is an important feature of atherosclerotic lesions, and increased production of the acute-phase reactant. C-reactive protein (CRF), is associated with a poor prognosis in severe unstable angina. We have investigated the existence and possible significance of the acute-phase responses of CRP and another sensitive reactant, serum amyloid A protein (SAA), in patients with unstable or stable angina.
We used new ultrasensitive immunoassays to measure CRP and SAA concentrations in plasma from 2121 outpatients with angina (1030 unstable, 743 stable, the rest atypical) enrolled in the European Concerted Action on Thrombosis and Disabilities (ECAT) Angina Pectoris Study. All patients underwent coronary angiography and extensive clinical and laboratory assessment at study entry, and were then followed up for 2 years. All suspected coronary events during follow-up were reviewed by an independent endpoint committee.
75 individuals (41 with unstable, 29 with stable, and 5 with atypical angina) had a coronary event during follow-up. Concentrations of CRP at study entry were associated with coronary events in patients with stable or unstable angina: there was about a two-fold increase in the risk of a coronary event in patients whose CRP concentration was in the fifth quintile (> 3.6 mg/L), compared with the first four quintiles. A third of the events occurred among patients who had a CRP concentration of more than 3.6 mg/L. CRP concentrations were positively correlated with age, smoking, body-mass index, triglycerides, extent of coronary stenosis, history of myocardial infarction, and lower ejection fraction. By contrast, concentrations of SAA were not associated with risk of a coronary event.
We found that raised circulating concentrations of CRP are predictors of coronary events in patients with stable or unstable angina. The modest acute-phase responses of CRP were probably not the result of myocardial necrosis. Whatever the underlying mechanisms, the sensitive measurement of CRP as a prognostic marker may be useful in the management of coronary heart disease.
炎症是动脉粥样硬化病变的一个重要特征，急性期反应物C反应蛋白（CRP）产生增加与严重不稳定型心绞痛的不良预后相关。我们研究了不稳定型或稳定型心绞痛患者中CRP及另一种敏感反应物血清淀粉样蛋白A（SAA）急性期反应的存在情况及其可能的意义。
我们采用新型超敏免疫测定法，检测了参与欧洲血栓形成与残疾协同行动（ECAT）心绞痛研究的2121例门诊心绞痛患者（1030例不稳定型、743例稳定型，其余为非典型型）血浆中的CRP和SAA浓度。所有患者在研究开始时均接受了冠状动脉造影以及广泛的临床和实验室评估，随后进行了2年的随访。随访期间所有疑似冠状动脉事件均由一个独立的终点委员会进行审查。
75例患者（41例不稳定型、29例稳定型、5例非典型型心绞痛）在随访期间发生了冠状动脉事件。研究开始时CRP浓度与稳定型或不稳定型心绞痛患者的冠状动脉事件相关：CRP浓度处于第五分位数（>3.6mg/L）的患者发生冠状动脉事件的风险比前四个分位数的患者增加约两倍。三分之一的事件发生在CRP浓度超过3.6mg/L的患者中。CRP浓度与年龄、吸烟、体重指数、甘油三酯、冠状动脉狭窄程度、心肌梗死病史及较低的射血分数呈正相关。相比之下，SAA浓度与冠状动脉事件风险无关。
我们发现，循环中CRP浓度升高是稳定型或不稳定型心绞痛患者冠状动脉事件的预测指标。CRP适度的急性期反应可能并非心肌坏死所致。无论潜在机制如何，将CRP作为预后标志物进行灵敏检测可能有助于冠心病的管理。
