依达拉奉联合他汀类药物对缺血性脑卒中患者血清同型半胱氨酸、C反应蛋白、血脂水平的影响

目的观察缺血性脑卒中患者在给予依达拉奉联合他汀类药物治疗后血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白(HDL)和低密度脂蛋白胆固醇(LDL-C)水平变化。方法 63例脑卒中患者分为2组,对照组27例给予瑞舒伐他汀,观察组36例在对照组治疗基础上给予依达拉奉治疗。检测体内Hcy、TG、TC、HDL及LDL-C水平变化,同时在治疗前与治疗14 d后填写脑卒中量表NIHSS、日常生活能力Barthel指数自评表、焦虑自评表(SAS)及抑郁自评表(SDS)。结果观察组Hcy、CRP及LDL-C水平显著低于对照组,HDL显著高于对照组。观察组患者在治疗14 d后总有效率达88.89%,显著高于对照组的77.78%。观察组患者Barthel指数显著高于对照组,SAS、SDS指数均显著低于对照组(P0.05)。结论依达拉奉联合瑞舒伐他汀可显著提高缺血性脑卒中患者的治疗效果,优化患者预后及生活能力。     

缺血性脑卒中患者纤维蛋白原和C-反应蛋白水平与颈动脉粥样硬化的关系

目的 探讨缺血性脑卒中患者颈动脉粥样硬化与纤维蛋白原和高教C-反应蛋白水平的关系。方法 对缺血性脑卒中患者应用颈部多普勒超声检测颈部血管内中膜厚度覆斑块形成情况，并同期检测患者血纤维蛋白原和高敏C-反应蛋白浓度。结果 125例患者中40例发现有颈动脉粥样硬化病变，其中16例经超声检查诊断为颈动脉粥样硬化斑块，24例诊断为颈动脉内中膜增厚。颈动脉粥样硬化病变的患者平均纤维蛋白原和高敏C-反应蛋白水平显著高于无颈动脉粥样硬化组（P〈0．05和P〈0．01）。并且随着平均纤维蛋白原水平和高敏C-反应蛋白水平升高颈动脉粥样硬化病变的发生率升高。结论 缺血性脑卒中颈动脉粥样硬化和纤维蛋白原、高敏C-反应蛋白水平之间有密切的相关性。     

Clinical relevance for lowering C-reactive protein with statins

The role of statins in the protection of atherosclerosis and reducting cardiovascular (CV) events is well established. On the other hand, the role of inflammation in the propagation and propensity to CV events has also been demonstrated. High-sensitivity C-reactive protein (CRP) which is involved in the immunologic process of inflammation has received the interest for its use in screening and risk reclassification. However, evidence for its causal relationship with atherothrombosis is lacking, and even more, knowing that statins influence on the reduction of CRP levels, a relevant evidence of their clinical benefits in this regard is also lacking. This article reviews four different key points regarding the issue, to better understand the current state and application of the treatment with statins in order to achieve benefits from lowering CRP’s levels regarding CV diseases: (1) the mechanisms of reduction of CRP levels by statins; (2) the role of statin-mediated CRP reduction in the atherosclerotic plaque regression; (3) the role in the prevention of CV diseases; and (4) the role in case of secondary prevention. With this basis, the reduction of CRP levels should be interpreted as a reduction of inflammatory burden thus its clinical benefits could be more interesting in secondary prevention.

• KEY MESSAGES

• It could be admitted a role of statin-mediated CRP diminution to reduce the rate of progression in atherosclerotic plaque.

• In general, and in the absence of specific clinical trials, the role of statins by lowering CRP and consequently, preventing cardiovascular events may be superior in case of secondary prevention because a more pronounced state of inflammation and regardless of its levels at baseline.

     

Correlation of disease activity in systemic vasculitis with serum C-reactive protein measurement. A prospective study of thirty-eight patients

In a prospective study over 2 years, serum C-reactive protein (CRP) concentration and erythrocyte sedimentation rate were measured serially in thirty-eight patients with various types of necrotizing systemic vasculitis. The CRP concentration was always elevated in patients with active vasculitis and fell rapidly in association with clinical remission induced by immunosuppression. During periods of complete remission, in the absence of any intercurrent condition, the value remained within the normal range. In contrast the sedimentation rate responded more slowly to changes in disease activity and did not necessarily reflect the level of inflammation at a particular time. These results, together with the commercial availability of rapid and precise assays for CRP, indicate that serial measurement of the serum CRP fills the urgent need for an objective index of the activity of the systemic vasculitides and their response to therapy.     

Peak C-reactive protein levels do not predict 30-day mortality for bacteremia: A retrospective cohort study

IntroductionAlthough peak C-reactive protein (CRP) levels are correlated with the prognosis of some diseases, there have been no reports regarding the association between peak CRP levels and mortality in patients with bacteremia. The present study aimed to determine the association between peak CRP levels and prognosis in patients with bacteremia.MethodsThis retrospective cohort study was conducted in a single tertiary hospital and included patients with bacteremia admitted to the emergency department from November 2012 to March 2017. Cox regression analysis was performed to examine the association between peak CRP levels and 30-day mortality. We also performed propensity score adjustment using potential confounding factors.ResultsOne hundred fifty-nine patients were included in the study. Peak CRP levels were significantly higher in the β-hemolytic streptococci (P = 0.001) and Streptococcus pneumoniae (P = 0.003) groups. The C-statistic of the multivariate logistic regression model for the propensity score was 0.88. For 30-day mortality, peak CRP levels >20 mg/dL did not show significance in the Cox regression analysis (hazard ratio, 0.866; 95% confidence interval, 0.489–1.537; P = 0.62). Even after propensity score adjustment, no significance was noted (hazard ratio, 0.865; 95% confidence interval, 0.399–1.876; P = 0.71).ConclusionsPeak CRP levels were not an independent predictor of mortality in patients with bacteremia in the emergency department. Clinicians should consider that patients with extremely high peak CRP levels do not necessarily have high mortality and vice versa.     

C-reactive protein as an indicator of sepsis

Objective: To determine the use of plasma C-reactive protein (CRP) concentrations, body temperature (BT) and white blood cell count (WBC) in the detection of sepsis in critically ill patients. Design: All patients admitted for more than 24 h in the intensive care unit (ICU) were prospectively included. Patients were followed up to ICU discharge and each patient-day was classified in one of four categories according to the infectious status: 1) Negative, patient-day without systemic inflammatory response syndrome (SIRS); 2) Definite, patient-day with SIRS and a positive culture; 3) SIRS, patient-day with SIRS and negative or no cultures. The last group was subdivided according to the following criteria: a) new, or persistence of, pulmonary infiltrates, b) the presence of pus in a place known to be sterile. Patient-days without these criteria were classified as SIRS with improbable sepsis (Unlikely), and with one criteria or more as SIRS with probable sepsis (Probable). Setting: Medical/surgical intensive care unit. Patients: Twenty-three patients were followed. Measurements and results: A total of 306 patient-days were analysed: 20 Negative, 15 Definite, 63 Unlikely and 208 Probable. The median (range) CRP values for Negative, Unlikely, Probable and Definite groups were as follows: 24.5 (7–86), 34 (5–107), 143 (39–544), and 148 (52–320) mg/l. The plasma CRP levels were significantly related to the infectious status (Negative, Unlikely, Probable or Definite) of the patient-day classification (p < 0.05). Concentrations of CRP in the Negative and Unlikely groups were significantly lower than in the Probable and Definite ones (p < 0.05). A plasma CRP of 50 mg/l or more was highly suggestive of sepsis (sensitivity 98.5 %, specificity 75 %). Conclusions: Daily measurement of CRP is useful in the detection of sepsis and it is more sensitive than the currently used markers, such as BT and WBC. Received: 22 December 1997 Accepted: 8 July 1998     

灯盏花素治疗急性脑梗死对超敏C反应蛋白的影响及疗效机制

目的 探讨灯盏花素治疗急性脑梗死对超敏C反应蛋白(hsCRP)的影响及疗效机制.方法 采用酶联免疫吸附法(ELLSA法)分别在第2、7、14天检测治疗组、对照组、健康对照组血清hsCRP水平.观察并记录病例治疗前及治疗后第7、14、30天的神经功能评分.结果 急性脑梗死患者血清hsCRP水平较健康对照组明显增高,血清hsCRP水平与神经功能缺损程度呈正相关;治疗组血清hsCRP水平在治疗后第7、14天较对照组明显降低(P＜0.05),神经功能评分在治疗后第7、14、30天时与对照组比较差异有统计学意义(P＜0.05,P＜0.01);治疗组未见明显不良反应.结论 血清hsCRP水平与脑梗死及病情严重程度密切相关,是脑梗死的危险因素.灯盏花素治疗急性脑梗死时可降低hsCRP水平,抑制急性脑梗死后的血管炎性反应,减轻神经功能障碍,改善脑梗死患者预后.灯盏花素治疗急性脑梗死具有一定的疗效及安全性.     

子宫内膜异位症患者药物保守治疗前后血清C反应蛋白水平比较研究

目的通过检测子宫内膜异位症患者(EMs)在药物保守治疗前后的血清超敏C反应蛋白(hsCRP)含量的变化,探讨子宫内膜异位症药物治疗的效果。方法检测Ems患者药物治疗前的血清hsCRP水平,半年后根据治疗转归结果的不同分为有效组(42例)、无效组(32例),并查hsCRP进行比较分析。结果治疗前,2组患者血清hsCRP水平均高于健康对照组(P<0.01),2组组间比较无明显差异。半年后2组hsCRP水平均下降,但仍高于健康对照组(P<0.01);与无效组比较,有效组下降较为明显(P<0.01)。结论 EMs患者存在慢性无菌性炎症状态,其hsCRP水平与病情严重程度呈正相关,hsCRP可作为判断其病情的一个生物学指标,内科药物保守治疗可缓解EMs患者症状,抑制炎症反应,但难以完全治愈。     

血清CRP浓度与冠心病严重程度的关系

目的探索冠心病(CHD)患者血清CRP浓度与冠脉病变严重程度的关系及与相关指标间的相关性。方法测定101例冠心病患者血清CRP、CK、CK-MB、TC、TG和HDL-C,比较CRP与冠脉病变支数及各相关指标间的相关性,并以40名健康者的结果为对照。结果血清CRP冠心病组与健康对照组有显著性差异,冠心病组内AMI、冠状动脉一支病变、二支病变及三支病变间也有显著性,冠心病组的CRP水平与CK、CK-MB、TC、TG水平有相关性。结论冠心病患者血清CRP的水平升高,其升高程度与冠心病的严重程度相关且与相关指标有一定的相关性。     

他汀类药物对脑梗死患者血清C反应蛋白及预后的影响

目的探讨血清C反应蛋白(Creactiveprotein,CRP)及血脂水平与脑梗死病情严重性及预后的关系,进而了解他汀类药物对脑梗死患者血清CRP水平及预后的影响。方法采用随机、双盲、安慰剂对照的方法进行研究,将46例脑梗死患者分为对照组及辛伐他汀组(辛伐他汀40mg/d或阿托伐他汀20mg/d,连续用药7d)。治疗前后检测血清CRP、血脂、血清谷草转氨酶(AST)及血清肌酸激酶(CK)水平,应用美国国立卫生研究院卒中量表(NIHSS)及Barthel指数(BI)记分法对入选患者在入院时及3个月时的神经功能缺损程度进行评分。结果治疗前CRP水平与当时及3个月时病情显著相关(P<0.01,P<0.05),血脂水平则无此相关性。治疗后他汀组CRP水平下降,治疗前后的差值与对照组相比,差异有显著性(P<0.01)。各组入院时神经功能缺失程度评分与3个月后相比,差异有显著性(P<0.01),但不同组之间相比无明显差别。治疗后各组AST及CK水平无明显变化。结论脑梗死患者血清CRP水平与病情的严重性及预后相关。短期应用他汀类药物可以降低脑梗死患者血清CRP水平,安全性好,但对梗死后3个月的预后无明显改善作用。他汀类药物对脑梗死的疗效需要进一步研究。     

超敏C-反应蛋白与脑血管疾病危险因素的相关性研究

目的探讨超敏C-反应蛋白(hs-CRP)对急性脑卒中发生的影响及与脑血管疾病危险因素的关系。方法采用散射免疫比浊法检测118例急性脑卒中患者(急性脑卒中组,其中脑梗死86例,脑出血32例)和67例正常健康人(正常对照组)的hs-CRP水平,分析hs-CRP与脑血管疾病危险因素之间的关系。结果与正常对照组比较,急性脑卒中组hs-CRP水平显著升高(P<0.01),脑梗死组与脑出血组间比较差异无显著性。Pearson相关分析结果显示,hs-CRP值与脑血管疾病危险因素(年龄、体质指数、腹围、收缩压、舒张压、空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇)均呈显著相关(P<0.05或P<0.01);多因素逐步回归分析结果显示,hs-CRP值与收缩压、空腹血糖、甘油三酯、总胆固醇呈显著正相关(P均<0.01)。结论hs-CRP与急性脑卒中患病显著相关;血压、空腹血糖与血脂是影响hs-CRP的主要独立因素。     

A prospective study on C-reactive protein as a prognostic factor for survival time of terminally ill cancer patients

Goals of work C-reactive protein (CRP) has been investigated as a predictor of life expectancy in terminal cancer in one previous study. However, the other variables such as patient’s symptom or physical examination findings were not considered. The aim of this study is to prove serum CRP level as a predictor of survival time, considering patient’s symptoms, physical examination findings, and various serological variables in terminally ill cancer patients with a prospective cohort design. Patients and methods Forty-four terminally ill cancer patients were divided into two groups by serum CRP levels and followed up until death. We adjusted the influence of some clinical and laboratory variables on survival by use of Cox’s proportional hazard model. Using the stepwise variable selection method, we found the final model. For 19 patients, CRP levels at 2 weeks and a week before death were compared by Wilcoxon signed ranks test. Main results All 44 study subjects died during the study period, and the median survival time was 17 days. Survival time of the elevated CRP group (≥2.2 mg/dl) was found to be significantly shorter than the lower CRP group in univariate analysis (hazard rate = 3.221, P = 0.001). In multivariate analysis, elevated CRP level (≥2.2 mg/dl) was selected as one of the unfavorable indicators regarding survival. Dyspnea and hyperbilirubinemia were also found significant predictors of shorter life expectancy in the final model. Serum CRP levels were significantly increased between the first and the second week before death. Conclusions Our results showed that serum CRP level can be a useful indicator predictive of survival time of terminally ill cancer patients.     

Impact of serum C-reactive protein measurements in the first 2 days on the 30-day mortality in hospitalized patients with severe community-acquired pneumonia: A cohort study

Introduction

The purpose of the study is to evaluate the impact of daily consecutive measurements of C-reactive protein (CRP) in the initial 2 days of hospitalization on the 30-day all-cause mortality in patients with severe community-acquired pneumonia (CAP).

Methods

We used 4 different thresholds of fractional decrease (FD) in CRP at the second day of admission (CRP2) of 25%, 30%, 40%, and 60%. In addition, we studied the association of each of these thresholds with the 30-day all-cause mortality.

Results

The mean age was 64 ± 20; males, 59%. The 30-day mortality rate was 18% (20/111). The mean serum CRP levels at the first day of all study group and CRP2 were 203 ± 98 vs 146 ± 92 mg/L, respectively, P = .05. The mean FD in CRP2 levels among the survivors was 33 %, whereas among the nonsurvivors, was 7%, P < .001. Multiple regression analysis revealed that FD less than 25% in CRP2 was associated with 30-day all-cause mortality, odds ratio of 3.07 (95% confidence interval, 2.84-5.03), P = .002, compared with those with FD more than 25% in CRP2.

Conclusions

Fractional decrease less than 25% in CRP levels at the second day was significantly associated with 30-day all-cause mortality in hospitalized patients with severe CAP.     

超敏C-反应蛋白与缺血性脑血管病危险相关性研究

目的：探讨超敏C-反应蛋白（hs-CRP）升高与缺血性脑血管病危险的相关性。方法：对122例缺血性脑血管病患者及60名健康对照者进行血清hs-CRP含量检测,其中短暂性脑缺血发作（TIA）组40例,急性脑梗死（ACI）轻型组35例,ACI中型组32例,ACI重型组15例。结果：TIA组、ACI轻型、中型和重型组的血清hs-CRP含量明显高于对照组（P〈0.01）。ACI重型组的血清hs-CRP含量高于中型组（P〈0.05）,ACI中型组的血清hs-CRP含量高于轻型组（P〈0.05）。TIA组、ACI轻型、中型和重型组的血清hs-CRP含量与它们的发病危险呈正相关,相关系数分别为0.306、0.437、0.618和0.745。结论：hs-CRP为缺血性脑血管病的独立危险因子,与它们的发病危险呈正相关,测定血清中hs-CRP含量是了解缺血性脑血管病发生、发展及预后的简单易行且有意义的重要指标。     

Plasma gelsolin levels and 1-year mortality after first-ever ischemic stroke

Purpose

Plasma gelsolin depletion has been associated with poor outcome of critically ill patients. We sought to investigate change in plasma gelsolin level after ischemic stroke and to evaluate its relation with disease outcome.

Materials and Methods

Fifty healthy controls and 172 patients with first-ever ischemic stroke were included. Plasma samples were obtained within 24 hours from stroke onset. Its concentration was measured by enzyme-linked immunosorbent assay.

Results

Plasma gelsolin level in stroke patients was significantly decreased compared with healthy controls. A multivariate analysis showed that plasma gelsolin level was an independent predictor for 1-year mortality (odds ratio, 0.945; 95% confidence interval [CI], 0.918-0.974; P = .0002) and negatively associated with National Institutes of Health Stroke Scale (NIHSS) score (t = −4.802, P < .001) and plasma C-reactive protein level (t = −4.197, P < .001). A receiver operating characteristic curve identified that a baseline plasma gelsolin level less than 52.0 mg/L predicted 1-year mortality of patients with 73.0% sensitivity and 65.2% specificity (area under curve [AUC], 0.738; 95% CI, 0.666-0.802). The predictive value of the gelsolin concentration was similar to that of NIHSS score (AUC, 0.742; 95% CI, 0.670-0.806; P = .940). Gelsolin improved the AUC of NIHSS score to 0.814 (95% CI, 0.747-0.869; P = .032).

Conclusions

Plasma gelsolin level is a useful, complementary tool to predict mortality after ischemic stroke.     

冠状动脉雷帕霉素洗脱支架术后C-反应蛋白水平的变化

目的探讨冠状动脉雷帕霉素洗脱支架术后血清C-反应蛋白(CRP)的变化。方法选取稳定型心绞痛及陈旧性心肌梗死行冠状动脉支架术患者,分为雷帕霉素洗脱支架组(SES组22例)及裸支架组(BMS组21例),观察置入支架术前及术后24、72h,1周、1个月的CRP水平。另取仅行冠状动脉造影的冠心病患者25例作为对照组。结果手术前3组CRP无明显差异,对照组CRP在介入术前后无明显变化(均P>0.05),两支架组术后24h及72hCRP与术前比较均明显升高(均P<0.01),但SES组CRP升高水平明显低于BMS组(P<0.01)。术后1周CRP恢复正常,与术前比较均无明显差异(均P>0.05)。结论冠状动脉雷帕霉素支架术仍引起了明显的体液炎症反应,但相对金属裸支架其炎症反应较低。     

急性脑卒中患者超敏C反应蛋白动态变化

目的：探讨超敏C反应蛋白动态变化与急性脑卒中患者临床转归的关系。方法：急性脑卒中患者157例按预后分为存活组（128例）与死亡组（29例）,按病因分为脑梗死组113例和脑出血组44例。比较各组患者发病第1、7、14、21天的血压、神经功能评分、实验室检查及超敏C反应蛋白变化。结果：脑卒中患者发病第1天超敏C反应蛋白明显增加,存活组患者随着病情好转,血压下降、神经功能评分改善,超敏C反应蛋白逐渐下降;死亡组患者超敏C反应蛋白随神经功能评分恶化呈上升趋势,2组比较差异有统计学意义（P〈0．05）。脑梗死组和脑出血组患者血压、神经功能评分、常规生化检查及超敏C反应蛋白变化差异无统计学意义（P〉0．05）。结论：动态观察超敏C反应蛋白变化,有助于判断急性脑卒中患者的临床转归和预后。     

缺血性中风与血小板颗粒膜蛋白关系的观察

目的：探讨血小板颗粒膜蛋白（ＧＭＰ１４０）在缺血性中风患者发病过程中的作用。方法：对３０例缺血性中风患者（观察组）和３０例健康体检者（健康对照组）采空腹静脉血３ｍｌ,用酶联免疫吸附双抗体夹心法测定血小板ＧＭＰ１４０含量。结果：缺血性中风患者的血小板ＧＭＰ１４０含量〔（６０．８５±６６．４２）μｇ／Ｌ〕明显高于健康对照组〔（１６．１８±１２．１３）μｇ／Ｌ〕,差异显著（Ｐ＜０．００１）。结论：缺血性中风患者血小板活化程度增高,在血栓形成过程中起重要作用;测定ＧＭＰ１４０含量可作为诊治缺血性中风的血液学指标之一。