血清C反应蛋白对非体外循环下冠状动脉旁路移植术临床疗效的影响

Effect of C-reactive protein on clinical outcome after off-pump coronary artery bypass surgery

目的探讨术前血清C反应蛋白水平对非体外循环下冠状动脉旁路移植术临床疗效的影响。方法将734例行非体外循环下冠状动脉旁路移植术的冠心病患者根据术前C反应蛋白水平分为CRP≥3．0mg／L组（386例）和CRP〈3．0mg／L组（348例），记录术后心血管事件发生情况，Logistic回归分析影响预后的相关因素。结果术后30d内CRP≥3．0mg／L组心血管事件发生率[4．9％（19例）]高于CRP〈3．0mg／L组[4．0％（14例）]，但差异无统计学意义（P〉0．05）；平均随访（5．2±1．8）年，CRP≥3．0mg／L组心血管事件发生率[22．0％（78例）]明显高于CRP〈3．0mg／L组[12．2％（40例）]，差异有统计学意义（P〈0．05），Logistic回归分析示：CRP≥3．0mg／L不能预测术后30d心血管事件发生情况，但是预测术后远期心血管事件最强因子，COX分析术前CRP≥3．0mg／L是影响患者预后的危险因素，其次左心室射血分数〈45％。CRP≥．0mg／L组5年实际生存率明显低于CRP〈3．0mg／L组[（90．0±1．2）％比（94．0±0．8）％，P〈0．05]。CRP≥3．0mg／L和左心室射血分数〈45％二者合并的患者5年生存率明显降低（88．0±0．4）％。结论血清C反应蛋白水平可以预测非体外循环下冠状动脉旁路移植术的远期临床疗效，提示血管壁的炎症程度与远期疗效相关。

Objective To investigate the relationship between serum levels of C-reactive protein（CRP） and cardiovascular events in patients with coronary heart disease after off-pump coronary artery bypass grafting. Methods From January 2002 to January 2007, we investigated 734 patients who underwent off-pump coronary artery bypass surgery. Preprocedural serum levels of CRP were measured in patients. According to the level of CRP, the patients were divided into two groups： CRP≥3.0 mg/L-group（386 cases） and CRP 〈 3.0 mg/L group（348 cases）. The cardiovascular events （angina pectoris, myocardial infarction and death） was carefully observed and recorded after the procedures. Results The incidence of early outcome was not significant between CRP ≥ 3.0 mg/L group and CRP 〈3.0 mg/L group at postoperative 30 days （4.9% vs 4.3%, P 〉0.05）. Follow-up period was mean （5.2 ± 1.8） years. The frequency of cardiovascular events was significantly higher in CRP≥3.0 mg/L group than that in CRP 〈 3.0 mg/L group （ 22.0% vs 12.2%, P 〈 0.05 ）. Multivariate analysis showed that preoperative CRP ≥3.0 mg/L did not seem to be an useful marker in predicting outcome after postoperative 30 days, But it was an inde- pendent predictor of late cardiovascular events. COX proportional hazards models showed that CRP≥3.0 mg/L was an independent predictor of late cardiovascular events, followed by left ventricular ejection fraction 〈 45%. Among operative survivors, patients in CRP 〈 3.0 mg/L group had significantly higher 5-year overall survival rate than those in CRP ≥ 3.0 mg/L group [ （94. 0 ± 0.8 ） % vs （90.0 ±1.2） %, P 〈 0.05 ], ClIP ≥ 3.0 mg/L combined with left ventricular ejection fraction 〈 45% were associated with significantly deereased overall survival after procedure （ 88.0 ± 0.4） %. Condclussions Serum levels of CRP may be a predietive of eardiovaseular events in patients with coronary heart disease after off-pump coronary artery bypass grafting. It indicates that long-term clinical outcomes are related to the enhanced inflammatory response of blood vessel.