冠脉成形术后炎症反应及其临床意义

Prognostic value of elevated C-reactive protein in unstable angina after percutaneous transluminal coronary angioplasty

目的 观察经皮冠状动脉腔内成形术 (PTCA)后血清炎症标志物C反应蛋白 (CRP)的变化 ,并研究术后CRP浓度与远期临床疗效的联系。方法 不稳定型心绞痛 (UA)患者 4 7例 ,用放射免疫法分别测定PTCA术前、术后 4 8h及术后 1wk血清CRP ,随访 9mon内临床再狭窄发生率 ,比较再狭窄组与无再狭窄之间血清CRP值。 2 5例冠脉造影 (CAG )术前、术后 4 8h的血清CRP作为对照。结果 PT CA术后 4 8hCRP较术前显著升高 (P <0 .0 1) ,而术后 1wkCRP值和术前无差异 ,CAG术前、术后的CRP无显著变化。随访期间有 13例患者诊断为临床再狭窄 ,其术后 4 8hCRP较非再狭窄组显著增高 (P <0 .0 1)。结论 PTCA术后 4 8h血清CRP较术前显著增高 ,与PTCA术后远期临床疗效密切相关。

Aim To observe the changes of serum C-reactive protein (CRP) in patients with unstable angina after percutaneous transluminal coronary angioplasty (PTCA) and to invetstigate the relationship between the peak values of CRP and clinical restenosis. Methods A prospective case study was undertaken in 47 patients who underwent successful PTCA (PTCA group)for unstable angina and another 25 patients as control who underwent coronary angiography. Levels of CRP were measured by RIA at baseline, 48 hours and one week after PTCA. All of PTCA group were followed clinically for 9 months. An exercise testing or a thallium perfusion scan (TPS) was performed within nine months post-PTCA and CAG was repeated in the part of abnormal patients. Results At nine-month follow-up, clinical restenosis developed in 44% of 25 patients with high serum levels(> 30 mg·L -1) of CRP, and in 9.1% of 22 patients with normal CRP levels(P< 0.01). Conclusion Serum CRP 48 hours after PTCA is a marker of nine-month clinical performance.