C反应蛋白和其他心血管标志物对经皮冠状动脉介入治疗术患者的长期预后作用  

C-reactive protein and other cardiovascular biomarkers are prediction of long-term outcomes in patients undergoing percutaneous coronary intervention

作　　者：吴炯[1] 郭玮[1] 刘晓文[1] 王冲[1] 徐雯[1] 张春燕 宋斌斌[1] 王蓓丽[1] 潘柏申[1] 

机构地区：[1]复旦大学附属中山医院检验科,上海200032

出　　处：《中华检验医学杂志》2014年第3期213-218,共6页Chinese Journal of Laboratory Medicine

基　　金：国家临床重点检验专科建设资助项目;“十二五”国家科技支撑计划子课题“中国人群常用临床检验项目参考区间及相关技术支撑体系的建立”资助项目（2012BAI37B01）

摘　　要：目的 探讨血清超敏C反应性蛋白（hs-CRP）与行经皮冠状动脉介入治疗（PCI）患者的危险分层、冠状动脉病变严重程度和长期预后价值的关系.方法 前瞻性收集2007年12月至2008年12月就诊于上海复旦大学附属中山医院心内科,行PCI的患者287例,测定患者术前hs-CRP及其他心血管危险标志物水平,平均随访54个月,记录主要心血管终点事件,分析心血管疾病（CVD）的相关危险因素.结果 心血管再入院患者与未再入院患者血清hs-CRP水平分别为2.21（0.10 ～54.17）mg/L和1.10（0.15～17.65） mg/L,差异有统计学意义（Z=-3.152,P=0.002）.心血管死亡患者与未死亡患者hs-CRP水平分别为6.60（0.43 ～ 82.51） mg/L和1.22（0.129～ 21.86）mg/L,差异有统计学意义（Z=-3.192,P=0.001）.hs-CRP与心肌钙蛋白T（cTnT）、WBC、多支病变、支架植入和低水平的高密度脂蛋白胆固醇（HDL-C）相关,且相关程度有统计学意义（t值分别为8.575、4.763和-2.770;P均＜0.05）.hs-CRP每升高一自然对数,心血管再入院率及心血管死亡率分别上升1.714倍（95％ CI,1.164 ～2.523）和5.023倍（95％ CI,2.003 ～ 12.600）.hs-CRP最高分位（3.65＜ hs-CRP≤82.51 mg/L）患者的心血管再入院率及死亡率分别为42.25％ （30/71）和9.86％（7/71）,均显著高于低分位（0＜hs-CRP≤0.59 mg/L）患者[Log-rank检验,再入院率20.83％（15/72）,x2=10.375,死亡率1.38％ （1/72）,x2=11.362,P均＜0.05].其中,hs-CRP＞ 3.0 mg/L患者的心血管再入院率和死亡率分别达43.75％ （35/80）和8.75％（7/80）,死亡患者的生存时间均小于20个月.结论 hs-CRP是心血管事件的独立危险因素.高水平hs-CRP与初次PCI术后患者5年内的心血管事件再入院和心血管事件死亡的发生率相关,可作为PCI术后患者危险度分层及预后评估的有力指标.Objective The association of high-sensivity C-reactive protein （hs-CRP） on patients undergoing percutaneous coronary intervention （PCI） and the long-term prognostic value were evaluated.Methods A prospective cohort study was prospectively conducted in 287 consecutive patients who were hospitalized in the Department of Cardiology of Shanghai Zhongshan Hospital undergoing primary PCI between Dec.2007 and Dec.2008.Levels of hs-CRP and other cardiovascular risk factors were determined before PCI.The patients were followed up for a mean of 54 months.Their cardiovascular end points were recorded.Results The mean value of serum hs-CRP in patients with cardiovascular disease （CVD） readmission and death was significantly higher than those without CVD readmission and death （2.21 mg/L versus 1.10 mg/L,Z=-3.152;6.60 mg/L versus 1.22 mg/L,Z=-3.192;P both 〈0.05）.The cardiac troponin T,WBC,multivessel disease,stent placement and the low HDL-C are the factors relating to serum hs-CRP levels.The coefficients of correlation have statistical significance （t =8.575,4.763 and -2.770;P 〈0.05）.The odd ratios for CVD readmissiom and CVD death were 1.714（95% CI,1.164-2.523）and 5.023 （95 % CI,2.003-12.600）.Kaplan-Meier survival analysis demonstrated a significantly reduced 5-year readmission rate in patients with 3.65 〈 hs-CRP ≤ 82.51 mg/L [43.75% （30/71） groups versus the lower hs-CRP level groups（20.83%,15/72） ; x2 =10.375,P 〈 0.001by Log-rank].The same as the death rate [9.86% （7/71） were evaluated in the lower hs-CRP level groups （1.38%,1/72） ;x2 =11.362,P 〈0.05 by Log-rank].The readmission rate and mortality in the patients with hs-CRP 〉3.0 mg/ L are 43.75% （35/80）and 8.75% （7/80）,respectively.The survival time was all less than 20 months.Conclusions The results demonstrated that hs-CRP is an independent risk factor in cardiovascular disease.High hs-CRP is strongly associated with 5-year occurance of readmission and death for cardiovascular events.Hs-CRP can be a stron

关 键 词：心血管疾病 C反应蛋白质 生物学标记 预后 

分 类 号：R54[医药卫生—心血管疾病]