摘要
炎性标记物水平升高是稳定性冠状动脉疾病患者未来发生血管事件的预测因素,其中包括高敏C-反应蛋白(hs-CRP)≥2.0m g/L。长期使用小剂量秋水仙碱是缓解炎症的一种安全有效的措施,因此作者进行此项开放性初步研究,以探讨在采用阿司匹林联合大剂量阿托伐他汀治疗、hs-CRP≥2.0m g/L的稳定性冠状动脉疾病患者中,秋水仙碱能否显著降低hs-CRP水平。
In patients with stable coronary artery disease, elevated levels of biomarkers of inflammation, including high-sensitivity C-reactive protein(hs-CRP) ≥ 2.0 mg/L, are predictors of future vascular events. Because long-term low-dose colchicine is a safe and effective means of dampening inflammation, we conducted an open-label pilot study to determine whether it could significantly lower hs-CRP in patients with stable coronary artery disease in whom hs-CRP was ≥ 2.0 mg/L despite taking both aspirin and high-dose atorvastatin therapy. Plasma hs-CRP was measured in 200 patients with clinically stable coronary artery disease who were taking aspirin and atorvastatin. In 64 patients, hs-CRP was ≥ 2.0 mg/L. In 20 of these patients, hs-CRP was measured again at 2 weeks(no treatment group), and in 44 patients, hs-CRP was measured again after 4 weeks of open-label colchicine 0.5 mg twice daily(treatment group). In the no treatment group, mean baseline hs-CRP did not decrease significantly, measuring 4.28± 2.03 mg/L at baseline and 3.70± 2.30 mg/L after repeated measurement(mean change 11.0% , 95% confidence interval[CI]- 30% to+ 9% , p=NS). In contrast, hs-CRP decreased in all patients administered colchicine, with mean baseline hs-CRP decreasing from 4.58± 2.05 to 1.78± 1.38 mg/L(p< 0.001), an absolute decrease of 2.80mg/L(95% CI 2.40 to 3.65 mg/L) and a relative decrease of 60% (95% CI 54% to 67% ). In 28 patients(64% ) in this group, the decrease in hs-CRP was >50% from baseline, and in 31 patients(70% ), hs-CRP decreased to< 2.0 mg/L. No significant side effects were reported. In conclusion, low-dose colchicine(0.5 mg twice daily) can effectively decrease hs-CRP in patients with clinically stable coronary artery disease and increased hs-CRP independent of aspirin and atorvastatin use. Additional controlled studies are warranted to confirm this observation and determine whether long-term use of low-dose colchicine can improve clinical outcomes in patients with advanced vascular disease.
