C反应蛋白对急性心肌梗死后左室重塑的相关性研究

目的:探讨C反应蛋白(CRP)与急性心肌梗死(AMI)后左室重塑的关系.方法:选54例首次确诊单纯前壁AMI患者分别于0、1、2、3、4、5、6天抽血查CRP计算CRp曲线下面积(CRPAUC),3～4天抽血查脑钠肽(BNP),心肌梗死(MI)后2月做超声心动图检查观察左室舒张末期容积指数(LVEDVi),左室收缩末期容积指数(LVESVi),室壁运动指数(WMSI)和左室射血分数(LVEF),根据CRP峰值分为CRP增高组和CRP正常组.设对照组35例,应用回归分析观察CRP峰值(CRRpeak),CRPAUC,BNP与左室重塑性指标的关系.结果:与对照组比较CRP峰值、BNP以及EDVi、ESVi、WMSi、和EF均有显著性差异,P＜0.05.CRP增高组与CRP正常组比较,除WMSi外BNP、EDVi、ESVi、EF均有显著性差异.单因素相关分析显示,CRPpeak,CRPAUC和BNP与ESVi、EDVi呈正相关(r值分别为0.738,0.573:0.876,0.714;0.624,0.577),而与EF呈负相关(r值分别为-0.625,-0.824,-0.531),尤以CRPAUC为显著.结论:CRP可以对AMI后左室重塑和左室功能不全强有力的预测因子,是影响预后的指标,CRP易于临床检测,可以为MI危险分层提供有价值的依据.

Relevance of C-reaction Protein and Left Ventricular Remodeling after Acute Myocardial Infartion

Objective: To discuss the relationship between C - reactive protein(CRP) and left ventricular remodeling. Methods: We prospectively studied 54 consecutive patients with a first acute anterior AMI, who received thrombolytic treatment and recanalized. We measured plasmas C - reaction protein (CRP )level on Days 0,1,2,3,4,5,and 6,and calculated the area under the curve(Auc). We measured plasmas brain natriuretic peptide(BNP) on Day 3 - 4. We also measured left ventricular end - diastolic volume index (EDVi), end - systolic volume index (ESVi), wall mation score index (WMSI) and ejection fraction (EF) by Echocardiography after 2 month. According to CRP peak, they were divided into the following groups: CRP elevated group and CRP normal group. 35 healthy subjects were recruited as control. Correlations between CRPpeak, CRPAUC, BNP and left ventricular remodeling were respectively obtained using linear regression analysis. Results: Compared with control group, CRPpeak, CRPAUC. BNP, EDVi and EDSi were higher (P < 0.05) and WMSI, EF were lower (P< 0.05). Compared with CRP normal group, BNP.EDVi and ESVi were higher (P < 0.05 -0.01) but EF was lower (P <0.05) . Correlation: CRPpeak, CRPAUC and BNP were positively correlated with ESVi and EDVi (r = 0.738, 0.573; 0.876, 0.714; 0.624,0.577 respectively, all P < 0.05) and inversely correlated with EF (r= -0.625, -0.824, -0.531). Among these, the CRPAUC showed the best correlation. Conclusion: Plasma CRP were strong predictors of remodeling and LV dysfunction and effect AMI prognosis. CRP is measured easily and usefully in clinic thus, CRP levels may provide information for long - term risk stratification after MI.