血清高敏感C反应蛋白和冠状动脉病变的关系

The relationship between serum high sensitivity C-reactive protein and coronary artery disease and the correlation analysis

目的 探讨血清高敏感C反应蛋白(hs-CRP)与冠心病的关系及其机制。方法检测经冠脉造影证实的67例冠心病患者和43例健康对照的hs-CRP水平,以性别,年龄,体重指数,是否合并高血压、糖尿病、冠心病家族史,白细胞计数,总胆固醇,甘油三酯,高密度脂蛋白胆固醇,低密度脂蛋白胆固醇,血清同型半胱氨酸,尿酸为危险因素,进行统计分析。结果冠心病组的hs-CRP水平为4.11±3.29mg/L,对照组为1.81±1.76mg/L,两者之间具有统计学差异(z=3.838,P=0.0001)。应用稳健回归的方法来分析发现只有合并糖尿病(P=0.047)和冠心病严重程度(P=0.003)与hs-CRP相关。高hs-CRP(≥1.5mg/L)者有冠心病的危险是hs-CRP<1.5mg/L者的2.58倍(P=0.018)。多元Logistic逐步回归显示血清hs-CRP水平是冠心病的一个独立危险因素(P=0.014)。若把hs-CRP分为五等分,hs-CRP每升高一个等分,冠心病严重程度增加一个或一个以上等级的可能性增加0.926倍。结论hs-CRP不仅是冠心病的独立危险因素,也是反映冠心病患者病情严重程度的一个敏感指标。

Objective To investigate the relationship between the serum high sensitivity C-reactive protein (hs-CRP) levels with coronary artery disease(CAD) and explore the interaction between hs-CRP and traditional risk factors. Methods Serum hs-CRP was measured by ultra sensitive immunoassay (rate nephelonetry with Beckman immunochemistry systems) in 110 Chinese subjects, aged 35-80 years, which included 67 CAD patients who were documented by coronary artery angiography and 43 normal controls. Gender, age, body mass index, total cholesterol, white blood cell(WBC) count, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) , serum homocysteine(Hcy) , smoking index(years×numbers of cigarettes per day), the complications of primary hypertension or diabetes, and CAD family history were analyzed. Results The serum level of hs-CRP in CAD patients[(4. 11±3. 29)mg/L] was significantly higher than that of hs-CRP in the normal controls[(1. 81±1. 76)mg/L], using a rank sum test analysis (z=3. 838, P = 0. 0001 ). Using a robust regression, hs-CRP positively correlated with no conventional risk factors except for diabetes and the severity of CAD. Logistic regression showed hs-CRP concentration was significantly related to CAD and the OR value was 2. 58 for those whose hs-CRP was equal to or more than 1. 5mg/L. In an ordinal logistic regression, the relative risks of developing more serious CAD augmented 0. 926-fold each increasing quartile of hs-CRP. Conclusions hs-CRP is a strong independent predictor for the occurrence of CAD and the severity of CAD.