C‐reactive protein: an independent predictor of cardiovascular disease in Aboriginal Australians

Objectives: We assessed the independent contribution of C‐reactive protein to the risk of cardiovascular disease in Aboriginal Australians. Methods: High sensitivity CRP levels were measured in 705 Aboriginal participants aged 20–74 years free from CVD at baseline. Participants were followed for a median of 11 years. Cox proportional hazards models were used to assess the association of CRP with the risk of developing CVD events. Results: A total of 114 participants were diagnosed with CVD. Incidence rates were 5.4 and 21.4 per 1,000 person‐years for the lower (<3 mg/l) and the higher (≥3 mg/l) CRP groups, respectively. After adjusting for age, sex, total cholesterol, systolic blood pressure, smoking status, diabetes, BMI and waist circumference, the association between CRP and CVD remained significant, with a hazard ratio of 2.40 (95% CI: 1.25, 4.62) for the higher CRP group relative to the lower CRP group. The population attributable risk was 52% (95% CI: 14%, 74%). Conclusions: CRP is an independent predictor of CVD in Aboriginal people. A large proportion of CVD cases are associated with elevated CRP levels. Therefore, controlling the conditions that cause inflammation may be beneficial to cardiovascular health in Aboriginal communities.     

不同类型炎症中C反应蛋白水平与基因型差异及其意义

目的研究不同类型炎症中C反应蛋白(CRP)含量与1059G/C基因型差异及其意义。方法采用免疫比浊法检测感染性炎症与自身免疫性炎症两组患者(各110例)及对照组(80例)患者血清高敏CRP含量,聚合酶链反应-限制性片段长度多态法检测各组CRP1059G/C基因型。计量资料经对数转换(LN)后以t或t’检验。结果感染性炎症者CRP值为(2.576±0.31)LN mg/L,升高持续时间平均为9.92 d,6 h内呈高值者21例(19.09%),48 h内呈高值者100例(90.91%);自身免疫性炎症者CRP值为(3.293±0.24)LN mg/L,升高持续时间平均为19.92 d,6 h内达高值者11例(10.00%),48 h内达高值者83例(75.45%);两组CRP值、CRP升高持续时间及呈高值时间比较,差异均有显著性(P<0.01)。两组炎症患者CRP 1059G/C基因型表现为GG,GC,CC三型,基因型和等位基因分布符合Hardy-Weinberg平衡,与对照组比较,差异无显著性(P>0.05)。GG基因型者CRP水平显著高于GC与CC型者(P<0.01)。结论自身免疫性炎症CRP升高水平及持续时间均高于感染性炎症,CRP 1059G/C基因型与等位基因分布无差异。不同基因型者CRP升高水平不同,GG型高于GC与CC型。     

降钙素原与高敏C反应蛋白联合检测在老年冠心病患者细菌感染中的临床应用

目的比较冠心病患者血液感染性指标的变化,分析降钙素原（PCT）和高敏C反应蛋白(hs CRP)在患者细菌感染中的临床诊断价值。方法选择2013年1月—2014年12月某院收治的冠心病患者,分别于治疗前（D0天）和治疗后第5天（D5）对诊断感染指标PCT、hs CRP、全血白细胞计数（WBC）、中性粒细胞计数（NEU）进行检测,比较细菌感染与非细菌感染组之间的差异,不同部位细菌感染,以及存活组和死亡组之间的差异。结果细菌感染组四项检测指标（PCT、hs CRP、WBC和NEU）均明显高于非细菌感染组;不同感染部位血清PCT和hs CRP水平比较,差异均具有统计学意义（均P<0.001）,其中以血流感染患者水平最高［分别为（45.148±46.341）ng/mL、（137.000±87.367）mg/L］,其次是胸腹腔感染和呼吸系统感染,泌尿系统感染患者最低［分别为（0.769±1.747）ng/mL、（53.006±45.450）mg/L］。存活组经治疗后各项检测指标均较治疗前低,而死亡组则不断增高。冠心病合并细菌感染患者血清PCT、hs CRP、WBC和NEU曲线下面积分别是0.934、0.856、0.782和0.784。结论联合检测血清PCT和hs CRP不仅可作为鉴别老年冠心病患者早期细菌感染的有效指标,还可用于病情评估,疗效判断,对评估感染的严重程度以及对患者预后的判断具有重要意义。     

超敏C反应蛋白检测在尘肺肺感染中的应用

目的探讨超敏C反应蛋白(hs-CRP)检测在尘肺肺感染中的应用价值。方法选择尘肺并发肺部感染患者40例为尘肺组,30例门诊男性体检者为对照组,检测hs-CRP值并进行分析;观察组检测hs-CRP、白细胞计数(WBC)、血沉(ESR)、痰培养,抗感染治疗后再次测定上述指标,进行统计分析。结果尘肺组hs-CRP值与对照组比较明显增高,两组比较,差异有统计学意义(P0.01);尘肺组hs-CRP阳性率与WBC、血沉、痰培养阳性率相比,差异有统计学意义(P0.05)。尘肺组hs-CRP值治疗后明显降低,与治疗前比较,差异有统计学意义(P0.01)。结论 hs-CRP的检测对尘肺肺部感染早期诊断和判断疗效有重要的实用价值。     

The use of prealbumin and C-reactive protein for monitoring nutrition support in adult patients receiving enteral nutrition in an urban medical center

Background: Serum prealbumin (PAB) is commonly used to assess protein status and is often used to monitor the response to nutrition support. However, during inflammation, the liver synthesizes acute‐phase proteins such as C‐reactive protein (CRP) at the expense of PAB. Objective: The purpose of this retrospective study was to determine whether changes in PAB reflect the delivery of adequate nutrients or changes in inflammatory status in hospitalized adults (≥18 years) receiving enteral nutrition (n = 154). Methods: Protein and energy intake were compared to changes in PAB, assessed at baseline and twice weekly. C‐reactive protein was assessed when PAB was <18 mg/dL to determine the presence and severity of inflammation. Results: In a sample of mostly critically ill patients, there was no significant difference in change in PAB for those receiving ≥60% of calorie needs (2.74 ± 9.50 mg/dL) compared to <60% of calorie needs (2.48 ± 9.36 mg/dL; P = .86). Changes in PAB correlated only with changes in CRP (r = ‐0.544, P < .001). In a subgroup analysis of 62 patients with repeated measures of PAB and CRP, PAB increased significantly only in the bottom 2 tertiles for calorie delivery and the lowest tertile for protein delivery. Conclusions: These results indicate that PAB may not be a sensitive marker for evaluating the adequacy of nutrition support in critically ill patients with inflammation. Only change in CRP was able to significantly predict changes in PAB, suggesting that an improvement in inflammation, rather than nutrient intake, was responsible for the increases in PAB levels.     

A multinomial model for comorbidity in England of long‐standing cardiovascular disease,diabetes and obesity

Comorbidity has been found to be significantly related to increased levels of mortality, decreased functional status and quality of life, increasing dependence on health services and an increased risk of mental and social problems. Previous research into comorbidity has mainly focused on identifying the most common groupings of illnesses found among elderly healthcare users. In contrast, this paper pools data from the Health Survey for England from 2008 to 2012 to form a representative sample of individuals in private households in England to explore the risk of comorbidity among the general population; and to take account of not only the demographic but also the socioeconomic and area‐level determinants of comorbidity. Using a multinomial logistic model, this research confirms that age and gender are significant predictors of cardiovascular disease, diabetes and obesity, whether examined singly or in any comorbidity combination. Across the seven possible disease combinations, the odds ratios are lowest for those individuals with a high income (6 of 7), home‐owning (5 of 7), degree educated (7 of 7) and living in the least deprived area (6 of 7), when controlling for demographic and smoking characteristics. The important influence of socioeconomic factors associated with comorbidity risk indicates that healthcare policy needs to move from a focus on age profiles to take better account of individual and local area socioeconomic circumstances.     

降钙素原、高敏C反应蛋白和白介素6对导管相关血流感染早期诊断的价值

目的研究降钙素原(PCT)、高敏C反应蛋白(hs-CRP)、白介素6(IL-6)对重症监护病房(ICU)患者导管相关血流感染(CRBSI)早期诊断的临床价值。方法选择某院2013年4月—2015年4月ICU留置中心静脉导管(CVC)疑诊CRBSI的78例患者,患者入住ICU及疑诊CRBSI当日采集患者血液标本,同时行血培养和静脉导管尖端培养,根据血培养和静脉导管尖端培养结果将患者分为CRBSI组与非CRBSI组,比较PCT、hs-CRP、IL-6对CRBSI诊断的价值。结果 28例疑诊患者最终诊断为CRBSI。疑诊CRBIS当日,CRBSI组患者的PCT、hsCRP、IL-6和血白细胞(WBC)水平分别为(3.35±1.52)μg/L、(32.90±11.10)mg/L、(423.20±171.70)ng/L、和(12.70±2.70)×109/L,均高于非CRBSI组[分别为(1.22±0.44)μg/L、(23.50±6.00)mg/L、(257.90±81.40)ng/L、和(11.20±1.90)×109/L],差异均有统计学意义(均P0.05)。ROC曲线分析:PCT、hs-CRP、IL-6和血白细胞(WBC)水平曲线下面积(AUC)及95%CI分别为0.92(0.85,0.99)、0.75(0.62,0.88)、0.80(0.67,0.92)和0.64(0.50,0.72);灵敏度分别为0.82、0.64、0.71和0.46;特异度分别为0.92、0.94、0.92和0.88。结论 PCT和IL-6对ICU患者CRBSI的早期诊断具有较高的价值,对及早诊断CRBSI具有一定的预测作用。     

通心络胶囊对不稳定心绞痛患者血清基质金属蛋白酶-9和高敏C-反应蛋白的影响

目的了解通心络胶囊对不稳定心绞痛患者血清基质金属蛋白酶-9(MMP-9)和高敏C-反应蛋白(hs-CRP)的疗效。方法 50例确诊为不稳定心绞痛的患者随机分为用药组和对照组,对照组给予常规药物治疗,用药组在常规治疗的基础上再给予通心络胶囊4粒/次,每日3次,分别于治疗前和治疗后12周测患者血清MMP-9和hs-CRP浓度。结果通心络胶囊治疗12周后患者血清MMP-9和hs-CRP的治疗前明显下降(P<0.05)。结论通心络胶囊能有效降低不稳定心绞痛患者血清MMP-9和hs-CRP的浓度。     

药物洗脱支架对不稳定型心绞痛患者介入治疗术后高敏C-反应蛋白的影响

目的探讨雷帕霉素药物洗脱支架（Cypher支架）对不稳定型心绞痛（UAP）患者介入治疗术后血清高敏C-反应蛋白（hs—CRP）的影响。方法在经皮冠状动脉介入（PCI）治疗过程中植入Cypher支架的UAP患者（Cypher支架组）42例，选择同期植入裸金属支架的UAP患者（普通支架组）46例作为对照。分别于术前、术后即刻、术后6h、术后24h、术后48h、术后72h、术后5d、术后7d和术后1个月取外周静脉血测定血清hs—CRP。两组患者均随访6个月。结果支架植入术后6h血清hs—CRP开始升高，术后48h达高峰，此后逐渐下降，至术后7d恢复到术前水平，术后1个月又见血清hs—CRP低于术前水平。Cypher支架组和普通支架组患者术后在各时间点血清hs—CRP的差异元统计学意义（P〉0．05）。术后6个月随访结果显示，Cypher支架组支架内再狭窄率（2．4％）显著低于普通支架组（19．6％），P〈0．05。结论PCI治疗增高患者血清hs—CRP水平；Cypher支架植入后诱导的急性炎症反应类似于普通支架，提示Cypher支架再狭窄率降低与雷帕霉索的抗炎作用可能无关。     

Eicosapentaenoic acid and docosahexaenoic acid containing supplements modulate risk factors for cardiovascular disease: a meta‐analysis of randomised placebo‐control human clinical trials

Background

Over 200 clinical trials have examined the effect of eicosapentaenoic acid (EPA ) and docosahexaenoic acid (DHA ) supplements on risk factors associated with cardiovascular disease. However, an updated analysis of the evidence is lacking. The aim of the present meta‐analysis was to quantify the effect of supplements containing EPA and DHA on risk factors for cardiovascular disease.

Methods

An analysis was carried on 171 clinical trials with acceptable quality (Jadad score ≥3) that were identified from a comprehensive electronic search strategy of two databases (Pubmed and Cochrane Library). A random effect model was used to obtain an overall estimate on outcomes of interest. Heterogeneity between trial results was tested for using a standard chi‐squared test.

Results

Compared with control, EPA and DHA supplements produced significant reductions of triglycerides of 0.368 mmol L^?1 [95% confidence interval (CI) = ?0.427 to ?0.309], systolic blood pressure of 2.195 mmHg (95% CI = ?3.172 to ?1.217), diastolic blood pressure of 1.08 mmHg (95% CI = ?1.716 to ?0.444), heart rate of 1.37 bpm (95% CI = ?2.41 to ?0.325) and C‐reactive protein of 0.343 mg L^?1 (95% CI = ?0.454 to ?0.232). This analysis indicates an increase in both low‐density lipoprotein cholesterol (mean difference = 0.150 mmol L^?1; 95% CI = 0.058–0.243) and high‐density lipoprotein cholesterol (mean difference = 0.039 mmol L^?1; 95% CI = 0.024–0.054). The triglyceride‐lowering effect was dose‐dependent.

Conclusions

The lipid‐lowering, hypotensive, anti‐arrhythmic and anti‐inflammatory actions of EPA and DHA supplements were confirmed in this analysis of randomised placebo‐control blinded clinical trials.

     

An evaluation of the model for end-stage liver disease and serum C-reactive protein as prognostic markers in intestinal failure patients on parenteral nutrition

Background: Intestinal failure (IF) patients require parenteral nutrition (PN) to avoid malnutrition and death. However, they face complications of recurrent sepsis and liver failure. By the time liver failure is discovered, it is often too late for intervention and prognosis on the waiting list is grim. The Model for End‐Stage Liver Disease (MELD) has traditionally been used to predict mortality in patients with liver failure but has never been analyzed in IF patients who are at risk for liver complications. C‐reactive protein (CRP) is an acute inflammatory marker that has been shown to reflect disease progression in nonalcoholic steatohepatitis, a disease that in many ways resembles PN‐associated liver disease. MELD and CRP are promising clinical markers of disease progression in IF patients on PN. Methods: The authors performed a retrospective, case‐control study to compare levels of MELD and CRP within the entire population of 133 adult patients referred to Northwestern Memorial Hospital for IF from 1999 to 2006. Results: Elevated MELD score is strongly predictive of increased mortality over the subsequent 6 months. Elevated CRP is strongly predictive over a smaller 3‐month window. One‐year mortality was significantly greater in patients who have either elevated MELD scores or serum CRP levels. Conclusions: In this study, the authors evaluated for the first time use of MELD and serum CRP as predictive markers of mortality in IF patients. Both seem to be promising clinical tools to identify which patients are at highest risk for complication.