高敏C反应蛋白在缺血性心脏病患者冠状动脉微血管功能障碍中的预测作用

Role of hs-CRP in predicting coronary microvascular dysfunction of ischemic heart disease patients

目的探讨高敏C反应蛋白(hs-CRP)在缺血性心脏病患者冠状动脉微血管功能障碍中的预测作用。方法选择行PCI的缺血性心脏病患者73例,根据hs-CRP水平分为高水平组41例(hs-CRP≥3mg/L),低水平组32例(hs-CRP<3mg/L)。通过速率比浊法定量血清hs-CRP水平,通过微血管阻力指数(IMR)评估冠状动脉微血管功能,Pearson相关性分析hs-CRP、肌钙蛋白及罪犯血管IMR之间的关系,通过logistic回归分析严重微血管功能障碍的预测因素。结果与低水平组比较,高水平组hs-CRP、PCI术前及术后IMR水平明显升高(P<0.05,P<0.01)。Pearson相关性分析显示,基线hs-CRP水平与PCI术前IMR、PCI术后IMR和肌钙蛋白Ⅰ峰值水平呈正相关(P<0.01)。肌钙蛋白Ⅰ峰值水平与PCI术前IMR和PCI术后IMR呈正相关(P<0.01)。logistic回归分析显示,hs-CRP≥3mg/L是严重微血管功能障碍的重要预测指标(OR=5.688,95%CI:2.242~14.508,P=0.000)。hs-CRP预测严重微血管功能障碍的最佳截断值为4.3mg/L(ROC曲线下面积=0.890),敏感性为85.51%,特异性为72.34%。结论 hs-CRP与静息冠状动脉微血管状态密切相关。

Objective To study the role of hs-CRP in predicting coronary microvascular dysfunction(MVD)in ischemic heart disease(IHD)patients.Methods Seventy-three IHD patients who underwent PCI in our hospital were divided into hs-CRP≥3 mg/L group(n=41)and hs-CRP<3 mg/L group(n=32).Their serum hs-CRP levels were measured by rate turbidimetry and their coronary microvascular function was assessed according to their index of microvascular resistance(IMR).The relationship among hs-CRP,troponin and criminal vascular IMR was analyzed by Pearson correlation analysis.The predictors of severe MVD were analyzed by logistic regression analysis.Results The serum hs-CRP level and vascular IMR were significantly higher in hs-CRP≥3 mg/L group than in hs-CRP<3 mg/L group before and after PCI(P<0.05,P<0.01).Pearson correlation analysis showed that the baseline hs-CRP level was positively related with the vascular IMR before and after PCI and the peak value of troponin Ⅰ after PCI(P<0.01),the peak value of troponin Ⅰ was positively related with the vascular IMR before and after PCI(P<0.01).Logistic regression analysis showed that hs-CRP≥3 mg/L was an important predictor of severe MVD(OR=5.688,95%CI:2.242-14.508,P=0.000).The optimal cutoff value of hs-CRP for predicting severe MVD was 4.3 mg/L(AUC=0.890)with a sensitivity of 85.51% and a specificity of72.34%.Conclusion hs-CRP is closely related with MVD of resting coronary artery.