Associations between change in C-reactive protein and serum lipids during statin treatment

Hypolipidaemic 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) treatment reduces cardiovascular risk and is also associated with the reduction of C-reactive protein (CRP) concentrations. However, there is scant data concerning the relationship between CRP and lipid changes during statin treatment. We studied 60 hypercholesterolaemic coronary patients who participated in the Treat to Target (3T) study comparing atorvastatin and simvastatin. Serum lipids and CRP (with a sensitive method) were measured before treatment at baseline and after 12 months of statin treatment. Low-density lipoprotein (LDL) cholesterol was substantially decreased and high-density lipoprotein (HDL) cholesterol increased during statin treatment. CRP decreased significantly (sign test P = 0.03) during treatment, and the changes of CRP were significantly associated with changes in HDL cholesterol (r = -0.45; P < 0.001) and apolipoprotein A1 (r = -0.40; P < 0.001) but not with changes in LDL cholesterol or triglycerides. The change in HDL cholesterol explained 20% of the change in CRP during statin treatment. The results are in line with previous suggestions that HDL has anti-inflammatory properties.     

ApoAI-phosphatidylcholine infusion neutralizes the atherothrombotic effects of C-reactive protein in humans

Summary.  Background:  High-density lipoprotein (HDL) exerts a variety of anti-atherothrombotic functions, including a potent anti-inflammatory impact. In line, the direct pro-inflammatory effects of C-reactive protein (CRP) can be attenuated by HDL in vitro . Objective:  To evaluate whether this also holds true in humans, we assessed the ability of reconstituted HDL to neutralize CRP-mediated activation of coagulation and inflammation. Methods:  Fifteen healthy male volunteers received an infusion of recombinant human (rh)CRP (1.25 mg kg⁻¹ body weight). In eight of these volunteers, an infusion of human apoAI reconstituted with phosphatidylcholine (apoAI-PC; 80 mg kg⁻¹ body weight) preceded rhCRP infusion. Results:  Infusion of rhCRP alone elicited an inflammatory response and thrombin generation. In individuals who received apoAI-PC prior to rhCRP, these effects were abolished. Parallel tests in primary human endothelial cells showed that apoAI-PC preincubation with rhCRP abolished the CRP-mediated activation of inflammation as assessed by IL-6 release. Although we were able to show that rhCRP co-eluted with HDL after size-exclusion chromatography, plasmon surface resonance indicated the absence of a direct interaction between HDL and CRP. Conclusion:  Infusion of apoAI-PC prior to rhCRP in humans completely prevents the direct atherothrombotic effects of rhCRP. These findings imply that administration of apoAI-PC may offer benefit in patients with increased CRP.     

High-density lipoprotein cholesterol, C-reactive protein, and prevalence and severity of coronary artery disease in 5641 consecutive patients undergoing coronary angiography

Background Although high‐density lipoprotein cholesterol (HDL‐C) and C‐reactive protein (CRP) are well‐established predictors for future cardiovascular events, little information is available regarding their correlation with the prevalence and severity of angiographically evaluated coronary artery disease (CAD). Material and methods Five thousand six hundred forty‐one consecutive patients undergoing coronary angiography for the evaluation of CAD were analysed. Cardiovascular risk factors were assessed by routine blood chemistry and questionnaire. CAD severity was graded by visual estimation of lumen diameter stenosis with significant stenoses defined as lumen diameter reduction of ≥ 70%. Coronary angiograms were graded as one‐, two‐ or three‐vessel disease, as nonsignificant CAD (lumen irregularities < 70%) or non‐CAD. Results HDL‐C (60·3 ± 18·5 vs. 51·9 ± 15·3 mg dL^?1; P < 0·001) was higher and CRP was lower (0·65 ± 1·68 vs. 1·02 ± 2·38 mg dL^?1; P < 0·001) in non‐CAD (n = 1517) compared to overall CAD patients (n = 4124). CAD patients were older (65·2 ± 10·5 years vs. 59·9 ± 11·4 years), more often diabetics (19·2% vs. 10·6%) and hypertensives (79·2% vs. 66·0%) and included more smokers (18·8% vs. 16·5%) (all P < 0·005). Low‐density lipoprotein cholesterol (124·5 ± 38·3 vs. 126·0 ± 36·3 mg dL^?1; P = NS) was similar in overall CAD and non‐CAD patients with more statin users (43·4% vs. 27·9%; P < 0·001) among CAD patients. Comparing non‐CAD with different CAD severities using analysis of variance, results did not change substantially. In a multivariate analysis, HDL‐C and CRP remained independently associated with the prevalence of CAD. In addition, HDL‐C is also a potent predictor for the severity of CAD. Conclusions In this large consecutive patient cohort, HDL‐C and CRP are independently associated with the prevalence of CAD. In this analysis, HDL‐C is an even stronger predictor for CAD than some other major classical risk factors.     

血清高敏C-反应蛋白与急性心肌梗死的相关性研究

目的 探讨血清高敏C-反应蛋白(hs-CRP)浓度与急性心肌梗死的相关性.方法 采用乳胶增强免疫比浊法测定356例急性心肌梗死(AMI)患者和356例健康者的血清hs-CRP浓度和血脂、尿酸浓度.结果 AMI患者血清hs-CRP浓度[(18.6±6.9)mg/L]明显高于健康对照组[(2.5±1.7)mg/L](P<0.01),而TG和LDL-C浓度在两组间差异亦均有统计学意义(均P<0.05),但不如前者差异显著.结论 血清hs-CRP浓度可预测AMI的发生,其预测价值甚至大于血脂水平.     

C-反应蛋白与原发性高血压的关系研究

目的探讨C反应蛋白与原发性高血压的关系。方法测定696例原发性高血压患者血清C反应蛋白、甘油三酯、胆固醇、极低密度脂蛋白及血糖水平等生化指标,并与613例健康者比较,分析C反应蛋白与原发性高血压及其危险因素的关系。结果高血压组与正常血压组血清C反应蛋白浓度分别为(1.91±1.85)g/L和(0.70±0.67)g/L,两组比较有显著性差异(P<0.01);且C反应蛋白浓度随着血压级别的增加而增加,经多元逐步回归分析,在排除高血压的其他危险因素影响后,C反应蛋白仍与原发性高血压相关(P<0.01)。结论C反应蛋白浓度与原发性高血压相关,炎症反应参与了原发性高血压的发生、发展。     

川崎病后超敏C-反应蛋白及血脂水平检测的临床意义

目的探讨血清超敏C-反应蛋白(high sensitivity C-reactive protein,Hs-CRP)和血脂水平与川崎病慢性期炎症的关系。方法川崎病患儿80例,分成两组,冠状动脉扩张组35例和冠状动脉无扩张组45例,对照组为健康儿童40例。采用免疫比浊法检测血Hs-CRP水平,酶法检测血总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平。结果三组儿童Hs-CRP、HDL-C浓度差异均有显著性(P<0.05),且冠状动脉扩张组均高于冠状动脉无扩张组和对照组(P<0.05);logistic回归分析示Hs-CRP、HDL-C与冠状动脉扩张密切相关。结论川崎病急性期过后仍有部分儿童存在血管的慢性低水平炎症,Hs-CRP与HDL-C是川崎病慢性期冠状动脉病变的可靠预测指标。     

短期辛伐他汀40 mg治疗不稳定型心绞痛对血浆高敏C-反应蛋白水平的影响

目的探讨使用大剂量(40 mg/d)和常规剂量(20 mg/d)辛伐他汀治疗2周后不稳定型心绞痛(UAP)患者血浆高敏C反应蛋白(hs-CRP)浓度的变化,分析短期强化降脂治疗对hs-CRP水平的影响。方法选取UAP患者76例,随机分为常规降脂组和强化降脂组,分别接受辛伐他汀20 mg/d和40 mg/d治疗,测定治疗前及治疗后1周、2周血脂[总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)]和hs-CRP水平。结果常规降脂组和强化降脂组治疗2周后TG、和HDL-C变化不明显,TC和LDL-C均呈下降趋势(TC:F=44.88,P<0.0001;LDL-C:F=32.92,P<0.0001),强化降脂组下降更明显常规降脂和强化降脂治疗后hs-CRP水平呈下降趋势(F=4.515,P=0.044),强化降脂组治疗2周后hs-CRP下降更明显。相关性分析显示治疗后血浆hs-CRP浓度的变化与同期血脂(TC、LDL-C、HDL-C、TG)水平的变化无显著相关性。结论短期辛伐他汀治疗可以明显降低TC和LDL-C,辛伐他汀40 mg/d强化降脂治疗效果更显著;强化降脂治疗可以使hs-CRP水平显著下降,但与血脂下降并不相关。     

单纯性肥胖成人血清高敏C反应蛋白、血脂水平与胰岛素抵抗的相关性研究

目的 探讨单纯性肥胖成人血清高敏C反应蛋白(hs-CRP)、血脂水平与胰岛素抵抗(IR)的关系.方法 选择单纯性肥胖成人99例[按体质量指数(BMI)分为i度肥胖组46例,ii度肥胖组38例,iii度肥胖组15例],单纯性超重成人56例及健康成人80例.测定所有入选对象的身高、体质量、腰围、臀围、空腹血糖(FBG)、空腹胰岛素(FIN)、血脂、hs-CRP水平,并计算胰岛素抵抗指数(HOMA-IR)、BMI及腰臀比(WHR).结果 hs-CRP、HOMA-IR、FBG、FIN、TG、TC、LDL-C、脂肪肝发生率随着BMI的升高呈逐渐升高趋势,HDL-C则呈现逐渐降低趋势.血清hs-CRP与BMI、WHR、FIN、HOMA-IR、TG呈显著正相关(P＜0.05～P<0.01),与HDL-C呈显著负相关(P<0.01),多元逐步回归分析提示,BMI、HOMA-IR、HDL-C是影响hs-CRP的独立危险因素.结论 单纯性肥胖成人存在IR,炎性因子hs-CRP的过量表达参与并加重单纯性肥胖成人IR、血脂紊乱的发生和发展.     

维持性血透患者C反应蛋白与血清营养指标、血脂及心功能关系探讨

目的 探讨维持性血液透析(MHD)患者C反应蛋白(sCRP)与血清营养指标、血脂及心功能的关系.方法 测定76例MHD患者和44例健康对照者血清sCRP、血红蛋白(HGB)、血清前白蛋白(PRE)、血清白蛋白(ALB)、转铁蛋白饱和度(TSAT)、血清胆固醇(CHOL)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL);应用超声心动图测定左室舒张末内径(LVEDD)、室间隔厚度(IVS)、射血分数(EF),并与sCRP进行相关性分析.结果 MHD患者sCRP水平显著高于健康对照组;sCRP与血清营养指标HGB、PRE、ALB、TSAT有负相关性,与CHOL有相关性,均P ＜ 0.05;与TG、HDL、LDL及心功能指标LVEDD、IVS、EF无相关性.结论 sCRP是反映MHD患者炎症及营养状态的一项敏感指标,与血脂关系不肯定,不能作为预示心功能的指标.     

超敏C反应蛋白与2型糖尿病患者动脉粥样硬化的相关性研究

目的探讨血清超敏C反应蛋白(hs-CRP)与2型糖尿病患者颈动脉粥样硬化的相关性。方法收集83例2型糖尿病患者和40例体检健康者血清,根据患者血清低密度脂蛋白胆固醇(LDL-C)水平将糖尿病组患者分为LDL-C水平增高组和LDL-C水平正常组,测定所有受检者血清hs-CRP水平及糖尿病患者颈动脉内膜中层厚度(IMT)。结果 hs-CRP水平在LDL-C增高组、正常组及对照组之间呈逐渐下降趋势,两两比较,差异具有统计学意义(P0.01);hs-CRP浓度与LDL-C浓度呈正相关(r=0.4781,P0.05);2型糖尿病患者中合并颈动脉粥样硬化者血清hs-CRP阳性率明显高于无颈动脉病变者(P0.01)。结论 2型糖尿病患者血清hs-CRP水平显著升高,且与患者LDL-C浓度及颈总动脉粥样硬化形成有一定的相关性。     

Phosphoethanolamine-complexed C-reactive protein: a pharmacological-like macromolecule that binds to native low-density lipoprotein in human serum

BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) is a cytosolic enzyme encoded by a housekeeping X-linked gene whose main function is to produce NADPH, a key electron donor in the defence against oxidizing agents and in reductive biosynthetic reactions. Many variants of G6PD have been described, mostly produced from missense mutations, with wide ranging levels of enzyme activity and associated clinical symptoms. METHOD: A single base extension assay is used, yielding a single base difference of the extended products. Primers are designed to amplify products of different sizes with distinct fluorescent dyes in order to accurately distinguish all possible combinations of genotypes (homozygous and heterozygous for each mutation) in a multiplex PCR analysis. RESULTS: We present the first application of a multiplex multicolour assay to detect 15 of the most frequent G6PD-related mutations in Spain, which are studied in three multiplex reactions. Capillary electrophoresis analysis of the amplified products enables easy, rapid, unambiguous and high-resolution discrimination between wild-type and mutant alleles, even though various mutations may be present in the multiplex analysis. CONCLUSION: The analytical method described herein offers greater diagnostic power in Spanish and Mediterranean populations and would facilitate automated genotyping in routine molecular diagnostics and large-scale genetic studies (e.g., newborn screening programs).     

2型糖尿病患者超敏C反应蛋白和血脂检测的应用研究

目的探讨2型糖尿病患者血清超敏C反应蛋白(hsCRP)与血脂的关系及其临床应用。方法用HITACHI7060C全自动生化分析仪检测49例2型糖尿病患者和53例健康体检者血清hsCRP、TC、TG、、HDLC、LDLC、ApoA1、ApoB。结果2型糖尿病组患者血清hsCRP、TC、TG、LDLC、ApoB均比健康对照组高,差异有统计学意义(其中hsCRP和ApoBP<0.01,其他P<0.05);HDLC低于健康对照组,差异有统计学意义(P<0.05);两组ApoA1比较无统计学意义。同时hsCRP浓度与TG、ApoB浓度呈正相关(r分别0.2159、0.1954,P<0.05);hsCRP浓度与HDLC浓度呈负相关(r为0.2705,P<0.01)。结论hsCRP作为一个炎症因子,在预测糖尿病并发心血管疾病中具有重要的临床意义;2型糖尿病患者常伴有血脂紊乱,提示患动脉粥样硬化的危险性增大。     

Diet and lifestyle are associated with serum C-reactive protein concentrations in a population-based study

C-reactive protein (CRP) has been proposed as an independent risk factor for cardiovascular disease. In this study we sought to investigate the association between several nutritional and lifestyle factors and serum CRP concentration in a population-based study. We studied 359 individuals (172 women, 187 men; age range 18-75 years) randomly selected from the town hall's registers and assessed their daily dietary intake using a 3-day estimated-food record. The median serum CRP concentration was 1.40 mg/L (range <0.10-47.48 mg/L; geometric mean 1.20 mg/L). We noted significant and independent direct associations between CRP and age, body-mass index, female sex, and serum triglyceride concentration. Bivariate analysis showed a significant inverse association between CRP and many nutrients (e.g., carbohydrates, proteins, lipids, thiamine, pyridoxine, tocopherol, and folate), but multiple-regression analysis indicated that only the effect of dietary folate intake was not dependent on other factors. Differences in folate intake did not produce changes in plasma homocysteine concentration, and we detected no negative correlation between dietary folate intake and log homocysteine (r = .02, P = .711). Strong positive correlations between the intake of folate and numerous other nutrients were found. This population-based study shows that a higher folate intake, in addition to other known constitutive and lifestyle factors, is significantly associated with a lower serum CRP concentration.     

血清超敏C反应蛋白与血液透析患者血管通路失功间的关系

目的探讨超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)与血液透析患者血管通路失功(vascular access failure,VAF)间的关系。方法选取2017年7月至2018年6月在北京市海淀医院血液净化中心进行规律血液透析患者105例,根据有无出现VAF将患者分为血管通路失功发生组(VAF+组)和血管通路失功未发生组(VAF-组),比较两组患者hs-CRP水平的差异。结果在12个月的随访中,17例患者出现≥1次VAF事件。VAF+组患者总蛋白水平显著低于血管VAF-组[(65.61±4.01)g/L与(68.98±5.66)g/L,P=0.021]。VAF+组男性比例低于VAF-组(29.41%与53.41%,P=0.07),但差异无统计学意义。VAF+组、VAF-组患者hs-CRP年变化水平比较差异无统计学意义[(0.33±5.49)mg/L与(0.57±4.45)mg/L,P=0.840]。总蛋白水平是VAF的独立性保护因素(OR值为0.889,95%CI 0.797~0.991,P=0.034);hs-CRP水平与血管通路事件无相关(OR值为1.018,95%CI 0.926~1.119,P=0.713)。结论hs-CRP与VAF之间无相关,血管内膜增生中微炎症的确切机制需要进一步研究。     

A two-site immunoradiometric assay for C-reactive protein in serum

An immunoradiometric assay was developed for C-reactive protein in serum. The assay had a sensitivity of 5 μg/l and good precision. Correlation with radial immunodiffusion (r = 0.916) and EMIT (r = 0.935) was close. A reference range for healthy adults of 0.05–4.0 mg/l was derived.     

衡水市健康人群血脂四项参考区间的调查分析

目的建立衡水地区健康人群总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)的参考区间。方法收集该地区各县市的16 403例健康个体,采用全自动生化分析仪测定血脂四项(TC、TG、HDL-C、LDL-C),按照不同性别和年龄分组,并对检测结果进行统计学分析。结果 TC 3.17~7.20mmol/L;TG 0.08~3.16mmol/L;HDL-C 0.94~2.30mmol/L;LDL-C 1.14~4.59mmol/L。结论衡水地区男、女性血脂结果存在差异,且不同年龄段结果也有所不同,建议不同性别不同年龄段建立各自的正常参考区间,以便更好地为临床提供诊断依据。     

辛伐他汀对脓毒症患者降钙素原、C反应蛋白及预后的影响

目的拟用辛伐他汀干预脓毒症,观察辛伐他汀对脓毒症患者降钙素原(PCT)、C反应蛋白(CRP)及预后的影响,以探索辛伐他汀调节炎症反应的相关机制。方法采用前瞻性随机对照研究,以2013年10月-2016年12月ICU收治的82例脓毒症患者为研究对象并随机分组。测定两组患者入院后体温,血PCT、CRP水平,白细胞计数以及28 d病死率情况;在使用辛伐他汀(40 mg/d)第10天随访患者的肝功能指标丙氨酸转氨酶(ALT)和肌红蛋白(Myo),以评估辛伐他汀对相关脏器功能的影响。结果42例干预组和40例对照组患者年龄、性别、APACHEⅡ评分、入院最高体温、合并心力衰竭、肾功能等均无显著差异。干预组与对照组患者的炎症指标(PCT、CRP)在第3天开始都出现明显的下降,PCT第5天为(4.76±1.58)μg/L与(8.62±2.92)μg/L,P=0.038;第7天为(1.35±0.36)μg/L与(2.79±0.98)μg/L,P=0.017;第10天为(0.45±0.07)μg/L与(1.61±0.48)μg/L,P<0.001。CRP第3天为(81.95±7.63)mg/L与(123.17±12.29)mg/L,P=0.003;第5天为(45.12±4.17)mg/L与(67.93±7.15)mg/L,P=0.006;第7天为(21.73±2.55)mg/L与(34.72±4.81)mg/L,P=0.007等。两组患者28 d病死率无显著差异。两组患者的ALT和Myo随访数据无显著差异。结论辛伐他汀能显著降低脓毒症患者的PCT、CRP等炎症指标,两组患者全因死亡率无差异,希望对临床上干预脓毒症提供新思路。     

C反应蛋白与心房颤动的关系

目的探讨C反应蛋白（CRP）作为系统炎症因子与心房颤动（房颤）发生和持续的关系。方法入选58例房颤患者，其中风湿性心脏病房颤36例，孤立性房颤22例；根据有无既往病史分为初发房颤组共20例，复发房颤组共38例；根据病变性质分为阵发性房颤组共24例，持续性房颤组共34例。选择门诊及住院检查身体健康者60例作为正常对照组。比较各组CRP水平高于复发房颤组，差异有统计学意义；持续性房颤组CRP水平高于阵发性房颤组，差异有统计学意义（P＜0.05）。持续性房颤组左房前后径明显增加，与阵发生房颤组左房前后径及对照组左房前后径相比，差异有统计学意义（P＜0.05）。在持续性房颤组，CRP与左房前后径存在正相关关系。结论 CRP水平升高可能参与心房颤动发生，提示炎症反应具有促进心房颤动的发生和持续作用。     

炎症因子C反应蛋白与高血压相关性研究进展

C反应蛋白（C-reactive protein,CRP）是一种非糖基化蛋白质,为一种炎症性标志物。目前已证实在冠状动脉粥样硬化性心脏病、糖尿病、吸烟、高血压等人群中CRP较正常人群升高,说明上述慢性疾病的发生发展过程中有炎症因素的参与。本文综述CRP与高血压间发生与发展的关系。     

心绞痛患者血清C-反应蛋白测定的临床意义

目的探讨心绞痛患者血清C-反应蛋白(CRP)测定在CHD诊断,治疗中的临床意义。方法观察了83例心绞痛患者入院后1、3、7、152、5日血清CRP浓度的变化,其中稳定性心绞痛(SA)患者38例,不稳定性心绞痛(UA)患者45例。结果UA组血清CRP浓度明显增高,与SA组和对照组间比较有显著差异(P<0.001),SA组与对照组比较,虽然两组同在正常人波动范围内,但有差异(P<0.05)。SA组和UA组患者入院1~25天经治疗后,SA组血清CRP浓度下降不明显。UA组在入院1~3天内CRP下降不明显,以后下降至接近SA组的水平。结论心肌缺血本身并不能明显引起血清CRP浓度的增高。心绞痛从SA到UA的发展过程中,血清CRP浓度在逐渐增高,并随着有效的治疗而接近对照组。因此,血清CRP测定在心绞痛的诊断、治疗中具有一定的临床意义。