急性冠状动脉事件注册评分与血浆超敏C反应蛋白的关系及对心血管事件的预测

Positive association between global registry of acute coronary events score and plasma high-sensitivity C- reactive protein and its predictive value for long-term cardiovascular events

目的探讨中老年急性冠状动脉综合征患者血浆超敏c反应蛋白（hs—CRP）水平与全球急性冠状动脉事件注册（GRAcE）风险评分的关系，并分析对中老年急性冠状动脉综合征患者远期（5年）发生心血管事件的预测价值。方法中老年急性冠状动脉综合征患者共138例，根据GRACE积分进行危险分层，将患者分为低危组、中危组及高危组。并根据hs—CRP水平将患者分为Q1～Q4组。患者出院后随访5年，观察患者不良心血管事件的发生情况。结果经对数转换的hs—CRP（1ghs—CRP）水平GRACE积分高的高危组患者为0．43±0．23，高于中危组0．21±0．04、低危组0．09±0．22（P一0．000）。从Q1至Q4组，GRACE积分随着hs—CRP水平升高而升高，Q1：（133．o±43．6）分、Q2：（161．9±60．2）分、Q3：（169，3±52．6）分、Q4：（188．4±47．5）分（P〈o．001）。相关分析结果显示，lghs—CRP与GRACE评分呈正相关（r=0．576，P〈0．001）。5年随访期间共发生心血管事件96例（69．6％）。利用ROC曲线分析血浆hs—CRP水平及GRACE评分对中老年急性冠状动脉综合征患者远期心血管事件的预测作用，两者的曲线下面积分别为0．821（95％CI：0．749～0．892，Pd0．001）和0．869（95％CI：0．80lno．938，P〈o．001）。两者预测中老年急性冠状动脉综合征患者远期心血管事件的差异无统计学意义（P：o．237）。结论hs—CRP和GRACE风险评分呈正相关，能较好地评估中老年急性冠状动脉综合征患者的临床风险。hs—CRP和GRACE风险评分两者均可较准确地预测中老年急性冠状动脉综合征患者远期心血管事件发生风险。

Objective To evaluate the correlation between plasma high sensitivity C-reactive protein （hs-CRP） level and global registry of acute coronary events （GRACE） scores, and its predictive value for long-term （5 years） cardiovascular events in middle-aged and elderly patients with acute coronary syndrome （ACS）. Methods 138 middle-aged and elderly patients with ACS were divided into three groups according to GRACE scores： low risk group, middle risk group, high risk group. And based on quartiles of hs-CRP levels, subjects were segregated into 4 groups （Q1 to Q4）. All subjects were followed up for about 5 years and adverse cardiovascular disease events were recorded. Results The hs-CRP level was gradually increased along with increasing risk according to GRACE risk stratification （hs-CRP low risk group, 0.09 i 0.22; middle risk group, 0.21 ＋ 0.04; high risk group, 0.43±0.23, P〈0. 001）. Meantime, GRACE risk scores were gradually increasedalong with increasing hs CRP levels from Q1 to Q4 （QI： 133.0-4 43.6; Q2： 161.9-＋-_ 60.2; Q3.. 169.3!52.6; Q4： 188.4_＋47.5; all P%0. 001）. Regression analysis showed that hs-CRP level was positively correlated with GRACE risk scores （r=0. 576, P%0. 001）. During a follow-up period of about 5 years, 96 cardiovascular events were recorded. Receiver operating characteristic（ROC）curve analysis showed that area under the ROC curve （AUC） of hs-CRP was 0. 821 （95%CI： 0. 749-0. 892, P^0.001） and AUC of GRACE risk score was 0.869 （95~CI： 0.801-0. 938, P%0.001） in the evaluation of the long-term risk of incident cardiovascular events. The differences in prediction of long- term cardiovascular events in middle-aged and elderly patients with ACS were not significant （P = 0. 237） between GRACE risk score and hs-CRP level. Conclusions Plasma hs-CRP level is positively associated with GRACE score. Both of them can predict long-term adverse cardiovascular events in middle-aged and elderly patients with acute coronary syndrome.