血清基础C-反应蛋白预测心血管事件发生及预后

Value of preprocedural serum levels of C-reactive protein in predicting cardiovascular events and prognosis

目的观察血清基础超敏C-反应蛋白(hs-CRP)水平对非冠心病、冠心病患者将来近、远期发生心血管事件及预后的预测价值。方法对327例住院接受冠状动脉造影(CAG)和/或介入治疗(PCI)患者术前测定血清基础hs-CRP水平,将患者分为CRP<0.3 mg/dl(n=162)和CRP≥0.3 mg/dl(n=165)两组,分析住院期间、术后1及6个月心血管事件发生率。结果基础血清CRP水平在急性冠脉综合征组比稳定性心绞痛、CAG正常者明显增高(5.15±0.40vs0.27±0.05,0.26±0.35,P<0.01);30 d内近期各类心血管事件发生率在ACS和CRP水平增高组明显高于SAP和CRP水平不高组(4.86%vs2.44%,P<0.05;16.36%vs3.70%,P<0.01)。远期6个月各类心血管事件发生率也是在ACS和CRP升高组显著高于SAP和CRP低者(12.50%vs6.10%,P<0.05;26.06%vs13.58%,P<0.01)。结论血清基础CRP水平无论是对PCI术后的冠心病患者,还是非冠心病患者有助于预测将来近、远期发生心血管事件危险及预后的强有力指标。

Objective To investigate whether the cardiovascular events and prognosis on non-coronary artery disease and coronary artery disease in a period of 1 month and 6 months could be predicted by baseline levels of C-reactive protein （CRP）. Methods Preproeedural serum levels of CRP were measured in 327 patients perpormed with CAG or PCI. the patients were divided into two groups： CRP 〈0. 3 mg/dl and CRP≥0. 3 mg/dl. The cardiovascular events and stent resteruosis, re-PCI, CABG, tachycardia arrhythmia were carefully observed and recorded intraprocedural in 1 month and 6 month after the procedures. Results The baseline level of CRP was significantly higher in the patients with acute coronary syndrome than those with stable angina pectoris and non-coronary artery disease （5.15 ± 0.40 vs 0. 27±0. 05, 0.26 ±0. 35, P 〈0. 01 ）. The frequency of cardiovascular events was significantly higher in acute coronary syndrome and high baseline levels of CRP than those with stable angina pectoris and normal baseline levels of CRP in 1 month （4. 86% vs 2. 44%, P 〈 0.05 ; 16.36% vs 3.70%, P 〈 0. 01 ）, The cardio vascular events and those in in-stentresternosis, re-PCI, CABG, tachycardia arrhythmia were significantly high in the acute syndrome than those with normal baseline levels of CRP and stable angina pectoris in 6 months too （12.50% vs6. 10%, P〈0.05; 26.06% vs 13.58%, P〈0.01）Conclusion Preprocedural CRP level may be a predictor in 1 month and 6 months outcome of patients undergoing CAD after PCI or non-CAD. It indicated that the complications and clinical resternosis in 6 months were markedly influenced by the preprocedual degree of inflammatory cell activation.