高敏C反应蛋白和颈动脉粥样硬化斑块对急性冠状动脉综合征的预示和诊断价值

Predictive and diagnostic value of high-sensitivity C-reactive protein and carotid atherosclerosis to acute coronary syndrome

目的探讨高敏C反应蛋白(hs-CRP)和颈动脉粥样硬化斑块与急性冠状动脉综合征(ACS)的关系,研究两者对ACS的预示和诊断价值。方法采用前瞻性队列研究方法,选择68例ACS患者、39例稳定型心绞痛(SAP)患者和39例冠状动脉造影正常成年人为正常对照组,测定hs-CRP并用彩色多普勒超声诊断仪检查颈动脉粥样硬化斑块。结果ACS组的hs-CRP明显高于SAP组,中位数±四分位数间距是(13.39±10.24)mg/L vs(2.10±2.16)mg/L(P<0.01)和正常对照组(1.90±3.05)mg/L(P<0.01),SAP组与正常对照组差异无统计学意义。ACS组斑块指数和Crouse积分明显高于SAP组,分别为3.00±1.00 vs 2.00±2.00和5.20±7.25 vs 4.60±6.80(均P<0.01),SAP组又明显高于正常对照组,分别为2.00±2.00 vs 0.00±1.90和4.60±6.80 vs 0.00±1.90(均P<0.01)。ACS组和SAP组的斑块数目明显多于正常对照组,分别为2.00±2.00、2.00±2.00 vs 0.00±1.00(均P<0.01),ACS组斑块数目与SAP组之间差异无统计学意义。ACS组和SAP组的内中膜厚度(IMT)明显多于正常对照组,分别为(1.15±0.85)mm、(0.90±1.00)mm vs(0.60±0.10)mm(均P<0.01),但ACS组与SAP组间差异无统计学意义。Logistic逐步回归分析显示只有hs-CRP、斑块指数与ACS高度密切相关(P<0.01)。结论hs-CRP、颈动脉斑块指数与ACS关系密切,hs-CRP联合颈动脉粥样硬化斑块超声检查有较好预示和诊断ACS作用。

Objective To investigate the association of high- sensitivity C-reactive protein（hs-CRP） and carotid atherosclerosis with acute coronary syndrome（ACS） and to predict the diagnostic value of the test of hs-CRP and carotid artery ultrasonography for ACS. Methods A prospective cohort study was conducted on 68 ACS eases and 39 subjects stable angina pectoris（SAP） eases and 39 normal subjects（excluded by coronary angiography as a normal matched control group）, hs-CRP was measured and carotid ultrasonography was performed with B-mode Doppler ultrasound imager. Results Comparison showed serum hs-CRP level was significantly higher than that in SAP group （13.39±10.24） mg/L vs （2.10±2.16） mg/L（ P 〈0.01） and control group （1.90±3.05） mg/L（ P 〈0.01）. There were no difference between SAP group and control group. In patients with SAP, plaque index and Crouse score were significantly lower than those in ACS group （2.00 ± 2.00 vs 3.00 ±1.00） and （4.60±6.80 vs 5.20 ± 7.25 （ P 〈 0.01） ,while those in SAP group were significantly higher than those in control group （2.00±2.00 vs 0.00±1.00） and （4.60±6.80 vs 0. 00±1. 90）（ P 〈0.01）. Plaque number was significantly higher both in patients with ACS and SAP than that in control group（2.00±2.00,2.00±2.00 vs 0.00±1.00） （allP 〈0.01） ,intima-media thickness（IMT） was significantly higher both in patients with ACS and SAP than that in control group （1.15 ±0.85） mm and （0.90±1.00） mm vs （0.60±0.10） mm （all P 〈0.01）, however, there were no difference between ACS group and SAP group. Logistic regression analysis revealed that hs-CRP and plaque index were significantly associated with ACS（ P 〈0.01）. Conclusion hs-CRP and plaque index are directly related to ACS. hs-CRP united with carotid artery ultrasonography provides a new reliable tool for prediction and diagnosis of ACS.