高敏C反应蛋白与急性冠状动脉综合征介入治疗后冠状动脉血流速度的相关分析

High Sensitivity C-reactive Protein and Coronary Flow Velocity in Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

目的探讨非ST抬高急性冠状动脉综合征(NSTE ACS)病人经皮冠状动脉介入治疗(PCI)后冠状动脉血流速度及住院期间心血管事件(MACE)与术前高敏C反应蛋白(hs-CRP)水平的相关关系。方法接受PCI治疗的NSTE ACS患者189例,其中不稳定型心绞痛(UAP)124例,非ST段抬高型心肌梗死(NSTEMI)65例;另有稳定型心绞痛患者(SAP)40例。术前测定hs-CRP水平,术中应用校正TIMI血流计帧法(cTFC)计算靶冠状动脉的TIMI帧数,术后记录住院期间MACE的发生。分析hs-CRP水平与冠状动脉病变严重程度的关系并探讨其与靶血管cTFC帧数的相关性;采用Logistic回归分析方法筛选MACE的危险因素。结果与SAP组比较,UAP组及NSTEMI组的hs-CRP水平明显升高(3.03±2.17,3.59±2.48 mg/Lvs1.96±0.62 mg/L,P<0.05)。NSTE ACS病人冠状动脉病变程度与术前hs-CRP呈直线相关(r=0.522,P=0.001);介入治疗后靶血管cTFC帧数与术前hs-CRP亦呈直线相关(r=0.657,P=0.001)。Logistic回归分析表明,术前hs-CRP水平是导致住院期间MACE发生的危险因素(OR 2.417,P<0.001)。结论NSTE ACS患者术前hs-CRP水平升高预示患者介入治疗后住院期间MACE的发生率较高,这可能与术中靶血管血流速度受影响有关。

Objective To investigate the association between the level of high sensitivity C-reactive protein（hs-CRP） and coronary flow velocity and major adverse cardiovascular events（MACE） in pa- tients with non-ST-elevation acute coronary syndrome（NSTE ACS）, who underwent percutaneous coronary intervention（PCI）. Methods The study population included 189 patients with NSTE ACS who received PCI and 40 control subjects with stable angina pectoris（SAP）. The Gensini scoring system was used to determine the results of the coronary angiography. Coronary flow patterns of the cases were determined by the corrected thrombolysis in myocardial infarction frame count method （cTFC）. The levels of serum hs-CRP were measured before PCI. performed using chi-square test and analysis o the degree of coronary artery lesions was anal linear regression. Multivariate analysis eval Comparison of categor f variance（AVONA）. T ical and continuous variables were he correlation between hs-CRP and hs-CRP and cTFC was analyzed by E was performed using logistic regression test. Results The level of plasma hs-CRP was significantly higher in the NSET ACS（3. 03±2.17, 3.59±2.48 mg/L vs 1.96±0.62 mg/L,P〈0.05） compared with SAP group. The hs-CRP level was correlated with the degree of coronary artery lesions（r=0. 522, P=0. 001）. The hs-CRP was corre- lated with the cTFC of target blood vessel after PCI（r= 0. 657, P = 0. 001）. And the level of hs-CRP was proved to be the risk factor of MACE in patients with NSTE ACS by means of Logistic regression test （OR 2. 417,P〈0.001）. Conclusion The elevated level of hs-CRP in patients with NSTE ACS after PCI is associated with an increasing incidence of MACE. This phenomenon is correlated with injured coronary artery flow velocity.