CRP与斑块破裂有关

Multiple plaque rupture and C-reactive protein in acute myocardial infarction.

目的 探讨多个斑块破裂、C反应蛋白（CRP）与急性心梗（AMI）预后的关系。背景多项研究表明破裂或不稳定斑块不仅存在于罪犯病变部位，而且还包括急性冠脉综合症（ACS）患者的整个冠脉系统。方法 用血管内超声观察斑块破裂和CRP浓度之间的关系。共检查45例首次AMI病人的45条梗死-相关动脉和84条其他的大冠脉。结果 21例病人（47％）在罪犯部位斑块破裂，11例病人（24％）在远离部位有17个斑块破裂。与一个斑块破裂或无破裂病人比较。多斑块破裂病例有多种危险因子者多2倍以上（分别为82％及40％、29％，P=0．01）。罪犯处斑块破裂的病人血浆CRP水平高于无斑块破裂者（分别为3．1及1．9mg/l，P=0．04），CRP水平与斑块数正相关（P〈0．01），虽然所有罪犯斑块均经PCI处理。多处斑块破裂者预后较差。结论 CRP水平与病人多个斑块破裂有直接关系，临床预后不佳。因此，斑块不稳定不只是血管的一个局部事件，而是反映了整个冠脉树的一个更普遍的炎症反应。

Objectives This study sought to investigate the relationship between multiple plaque ruptures, C-reactive protein （ CRP）, and clinical prognosis in acute myocardial infarction （AMI）. Background Several studies have demonstrated that ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some acute coronary syndrome （ACS） patients. Recent studies have reported that a ruptured plaque at the culprit lesion is associated with elevated CRP, which indicates a poor prognosis in patients with ACS. Methods We performed intravascular ultrasound in 45 infarct-related arteries and another 84 major coronary arteries in 45 first AMI patients. Results Plaque rupture was observed in 21 patients （47%） at the culprit site. Intravascular ultrasound revealed 17 additional plaque ruptures at remote sites in 11 patients （24%）. Patients with multiple risk factors were more frequently found in our multiple-plaque rupture patients compared with single-plaque rupture or nonrupture patients （82% vs. 40% vs. 29%, P = 0.01 ）. High-sensitive CRP levels had a positive correlation with the number of plaque ruptures （P 〈 0.01 ）. All culprit lesions were successfully treated by percutaneous coronary intervention. Patients with multiple plaque rupture showed significantly poor prognosis compared with others （P = 0.01 ）. Conclusions Multiple plaque rupture is associated with systemic inflammation, and patients with multiple plaque rupture can be expected to show a poor prognosis. Our results suggest that AMI treatment should focus not only on stabilization of the culprit site but also a systemic approach to systemic stabilization of the arteries.