残余炎症风险在冠状动脉粥样硬化性心脏病中的研究进展

Research progress of residual inflammation risk in coronary atherosclerotic heart disease

炎症反应贯穿于冠状动脉动脉粥样硬化发生发展的整个过程,与不良心血管事件的发生有密切关系。C反应蛋白作为体内炎症反应的主要下游标志物之一,其水平升高预示着不良心血管事件风险增加。一系列研究显示血脂达标的基础上炎症反应活动与患者预后相关。对此,有专家提出了残余炎症风险(RIR)的概念:即血浆低密度脂蛋白胆固醇降至1.8 mmol/L以下时血浆高敏C反应蛋白水平>2 mg/L。RIR在真实世界中的发生率并不低。PROVE-IT和IMPROVE-IT研究也证实控制RIR可进一步改善患者预后,为冠状动脉粥样硬化性心脏病患者的二级预防治疗提供新思路。RIR逐渐成为国际上的临床热点问题。本文将从5个方面对RIR在冠状动脉粥样硬化性心脏病中的研究进展展开综述。

Inflammation contributes to all stages of atherosclerosis process.It is closely related to adverse cardiovascular events.C-reactive protein(CRP)is a marker of inflammation.Elevated CRP level indicates high risk of adverse cardiovascular events.Studies demonstrate that inflammatory activity is concerned to poor prognosis even the level of blood lipid is within normal range.Residual inflammatory risk(RIR)refers to high-sensitive C-reactive protein(hs-CRP)>2 mg/L and low-density lipoprotein cholesterol(LDL-C)≤1.8 mmol/L.The incidence of RIR is not low.PROVE-IT and IMPROVE-IT studies show that controlling RIR can improve the prognosis of coronary atherosclerotic heart disease,which provides new ideas for secondary prevention and treatment of the disease.RIR becomes an international hotspot issuein clinical practice.This article reviewed the progress of RIR in coronary atherosclerotic heart disease.