高敏C反应蛋白预测冠状动脉痉挛患者预后价值的研究

Evaluation of high-sensitivity C-reactive protein in predicting prognostic value in coronary artery spasm patients

目的:评价高敏C反应蛋白(high-sensitivity C reaction protein,hs-CRP)预测冠状动脉痉挛预后的价值。方法:检测120例明确冠状动脉痉挛患者入院时血浆hs-CRP浓度,经治疗出院后进行电话/门诊随访6个月了解胸痛再发情况,对临床诸因素进行Logistic回归分析,研究冠状动脉痉挛再发的危险因素。建立ROC曲线,评价血浆hs-CRP判断冠状动脉痉挛预后的价值。结果:120例患者中再发胸痛36例,再发胸痛组hs-CRP浓度显著高于非胸痛再发组[中位数为5.4(4.6,7.5)mg/L比4.6(3.6,6.4)mg/L,P<0.05]。各临床因素进行Logistic回归分析,提示hs-CRP(OR=1.55,95%CI:1.02～1.35,P=0.03)和吸烟(OR=1.26,95%CI:1.12.～1.65,P=0.02)是冠状动脉痉挛复发的危险因素。入院hs-CRP在判断预后的ROC曲线下,面积为(0.83,95%CI:0.812～0.819,P<0.05),并将切点值定为1.6mg/L,此值预测胸痛再发敏感性和特异性分别为89%和81%。结论:hs-CRP增高和吸烟是冠状动脉痉挛胸痛再发的危险因素,以1.6mg/L为切点其预测预后的敏感性、特异性分别为89%和81%。

Objective： To evaluate the high-sensitivity C-reactive protein in predicting the prognosis in the hospitalized coronary artery spasm patients. Methods： A total of 120 confirmed coronary artery spasm pa- tients were enrolled in the study. During hospitalization, plasma hs-CRP concentrations were measured. ROC analysis was performed to evaluate the prognostic value and logistic regress analyses were used to evaluate if hs- CRP were an independent predictor for recurrent chest pain. Results： During 6 months follow-up, 36 patients suffered from recurrent chest pain and the remaining had no symptoms. The plasma hs-CRP concentrations in recurrent chest pain group were significantly higher than those of the remaining. [ 5.4 （4. 6, 7.5 ） mg/L vs. 4. 6 （ 3.6, 6. 4） rag/L, P 〈 0.05 ]. Area under receiver operating characteristic curve （ AUC ） to predict the prognosis was 0. 83 （95% CI： O. 812 -0. 819, P 〈 0.05）. the optimal plasma has-CRP cut-off point for pre- dicting the chest-pain reattack was 1.6mg/L, with a sensitivity 89% and specificity 81% and logistic analyses demonstrated that hs-CRP（ OR 1.55,95% CI： 1.02 - 1.35 ,P = 0. 03 ） and smoking（ OR 1.26,95% CI： 1.12. - 1.65,P = 0. 02） were independent predictors for the recurrence of chest pain. Conclusion ： C-reactive pro- tein and smoking may be risk factors for recurrence of chest pain during 6 month follow-up after discharge, the cut-off point for predicting recurrent chest pain werel. 6 mg/L in this patient cohort.