血清C-反应蛋白、可溶性CD40配体、基质金属蛋白酶-2水平与冠心病的相关性

目的:观察不同类型冠心病(CHD)患者血清中C-反应蛋白(CRP)、可溶性细胞分化抗原40配体(sCD40L)、基质金属蛋白酶-2(MMP-2)水平的变化情况,探讨炎性指标与冠状动脉狭窄程度之间的关系及与急性冠状动脉综合征(ACS)间的关系。方法:选取CHD患者65例,包括稳定型心绞痛(SAP)组21例、不稳定型心绞痛(UAP)组22例、急性心肌梗死(AMI)组22例。按Gensini评分法评定其冠状动脉狭窄程度。另16例冠状动脉造影正常者列为对照组。结果:UAP组和AMI组的血清CRP水平均均明显高于SAP组和对照组(均P<0.01),SAP组与对照组差异无统计学意义(P>0.05),AMI组较UAP组明显增高(P<0.01);血清sCD40L水平在对照组、SAP组、UAP组、AMI组逐渐增高,其中AMI组和UAP组较SAP组和对照组的差异有统计学意义(均P<0.01),而在AMI组和UAP组之间以及SAP组和对照组之间,差异无统计学意义(P>0.05);血清MMP-2水平在对照组、SAP组、UAP组、AMI组逐渐升高,且各组间均差异有统计学意义(均P<0.01)。这3个指标与冠状动脉狭窄程度间无相关性(P>0.05)。多元Logistic逐步回归分析显示CRP的风险比值(OR)为1.452,P<0.05;sCD40L的OR值为1.071,P>0.05;MMP-2的OR值为1.152,P<0.05。结论:血清CRP、sCD40L、MMP-2水平能反映CHD的严重程度,并可间接反映冠状动脉斑块的稳定性。CRP、MMP-2可能是ACS发生发展的重要危险因子。     

低密度脂蛋白胆固醇达标的冠心病患者餐后残粒脂蛋白-胆固醇水平及与冠脉病变严重程度相关性的研究

目的观察低密度脂蛋白胆固醇(LDL-C)达标的冠状动脉粥样硬化性心脏病(冠心病)患者餐后残粒脂蛋白-胆固醇(RLP-C)水平,并探讨其与冠状动脉病变严重程度的关系。方法连续入选2015年3月~2015年9月南京市胸科医院心内科收治的临床诊断为冠心病且低密度脂蛋白(LDL)达标的住院患者42例。按冠状动脉造影结果分为冠心病组及对照组,入院第2 d检查空腹及早餐后4 h的血脂水平:总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、LDL-C,使用公式法(RLPC=TC-HDL-C-LDL-C)计算得到RLP-C浓度,比较组间差异,并计算冠心病组冠状动脉病变Gensini评分,分析其与RLP-C的关系。结果两组空腹情况下TG、TC、LDL-C、RLP-C比较差异无统计学意义(P均0.05);对照组HDL-C高于冠心病组,差异具有统计学意义(P0.05)。两组餐后4 h情况下TG、TC、LDL-C比较差异无统计学意义(P均0.05);冠心病组RLP-C高于对照组,对照组HDL-C仍高于冠心病组,差异均具有统计学意义(P0.05)。冠心病组RLP-C增幅明显高于对照组,对照组HDL-C增幅高于冠心病组,差异均具有统计学意义(P0.05)。分析空腹、餐后4 h各个血脂指标以及血脂指标增幅和Gensini评分之间的相关性,RLP-C的餐后增幅与Gensini评分具有中度相关性(r=0.450,P0.05)。结论餐后RLP-C能够更好反应冠心病患者血脂水平及血脂相关性心血管剩留风险。     

不同临床类型冠心病患者血清NT-proBNP、hs-CRP浓度的相关性分析

目的通过比较不同临床类型冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)患者血清氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)和高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)浓度,并分析血清NT-proBNP和hs-CRP浓度与冠状动脉病变严重程度的关系及两指标间的相关性,以探讨其在CHD发生、发展过程中的临床意义。方法选取2015年2月至2017年5月惠东县第二人民医院心血管内科收治的CHD患者172例,分为稳定型心绞痛(stable angina pectoris,SAP)组(n=58)、不稳定型心绞痛(UAP)组(n=54)、急性心肌梗死(AMI)组(n=60),另选取同期性别、年龄匹配的健康体检者50名作为对照组。比较4组血清NT-proBNP、hs-CRP浓度和冠状动脉Gensini评分,采用Pearson相关分析分析CHD患者血清NT-proBNP和hs-CRP浓度与冠状动脉Gensini评分的关系及两指标间的相关性。结果与对照组比较,SAP组、UAP组和AMI组血清NT-proBNP、hs-CRP浓度和Gensini评分均明显升高,差异均具有统计学意义(P0.05);血清NT-proBNP和hs-CRP浓度均以AMI组最高,SAP组最低,各组组间两两比较,差异均具有统计学意义(P0.05);AMI组、UAP组Gensini评分明显高于SAP组,差异均具有统计学意义(P0.05),而AMI组、UAP组间比较,差异无统计学意义(P0.05);CHD患者中,血清NT-proBNP、hs-CRP浓度均与Gensini评分呈显著正相关(r=0.528,P0.01;r=0.485,P0.01);血清NT-proBNP和hs-CRP浓度呈显著正相关(P0.05)。结论血清NT-proBNP、hs-CRP浓度在CHD不同临床类型之间具有显著差异,且与冠状动脉病变严重程度密切相关,对CHD早期的诊断和病情严重程度的判断具有一定的临床意义。     

可溶性糖蛋白130与稳定型冠心病患者冠状动脉粥样硬化严重程度之间关系

目的: 评估稳定型冠状动脉疾病（stable coronary artery disease, CAD）患者血清白细胞介素-6（IL-6）、可溶性IL-6受体（sIL-6R）和可溶性糖蛋白130（sgp130）浓度及与冠状动脉粥样硬化严重程度间的关系。方法：纳入2017年1月到2019年1月间于惠州市第六人民医院心内科具有动脉造影适应症疑似冠心病患者89例,根据冠状动脉造影结果将患者分成两组：存在冠状动脉粥样斑块CAD组,即粥样斑块组,共64例;不存在冠状动脉粥样斑块CAD组,即非粥样斑块组,共25例。采用ELISA法检测两组患者血清IL-6、sIL-6R和sgp130浓度,Spearman相关分析sgp130浓度与受累冠脉数目及Gensini评分的相关性,多因素logistic回归分析冠状动脉粥样硬化斑块病变的预测因子。结果： 粥样斑块组与非粥样斑块组在年龄、BMI、高血压、糖尿病、血脂参数上无统计学差异（P>0.05）, 粥样斑块组患者男性吸烟者居多（P<0.05）。粥样斑块组血清sgp130浓度显著低于非粥样斑块组（314.97±84.39 VS 399.08±79.99 ng/ml, P<0.001）,粥样斑块组血清IL-6浓度显著高于非粥样斑块组（P<0.05）, 粥样斑块组血清sIL-6R浓度和C-反应蛋白浓度(CRP)与非粥样斑块组比较差异无统计学意义。多因素logistic回归分析示血清sgp130浓度是冠状动脉粥样硬化斑块病变存在的预测因子（P=0.018）。血清sgp130浓度与受累冠状动脉数目间呈负相关（r=-0.310,P=0.007）,Gensini评分指数与血清sgp130浓度呈负相关（r=-0.410, P=0.001）,稳定型CAD患者sgp130浓度是Gensini评分指数独立危险因素。结论：稳定型CAD患者血清sgp130浓度与冠状动脉损伤严重程度呈负相关,血清sgp130水平是冠状动脉粥样硬化严重程度血清标志物。     

血清超敏C反应蛋白水平与冠状动脉病变程度的相关性研究

目的：探讨冠心病（CHD）患者血清超敏C反应蛋白（hs-CRP）水平与冠状动脉病变程度的相关性。方法：对拟诊冠心病的170例患者用免疫散射比浊法进行hs-CRP检测,并行冠状动脉造影（CAG）检查,采用Gensini评分系统对冠状动脉血管病变程度进行定量评分,得出Gensini积分,统计分析冠状动脉狭窄程度与hs-CRP的相关性。结果：由低至高Gensini积分四分位分组后,hs-CRP在不同Gensini积分组间差异有统计学意义（P〈0.05）。hs-CRP的水平与Gensini积分呈显著正相关（R=0.382,P〈0.01）。结论：血清中hs-CRP浓度的含量与冠状动脉病变的程度呈正相关,可作为临床评价冠状动脉狭窄程度的指标之一。     

二尖瓣环钙化和冠状动脉粥样硬化严重程度的关系

目的探讨二尖瓣环钙化(mitral annulus calcification,MAC)与冠状动脉粥样硬化严重程度的关系。方法纳入计划行冠状动脉造影的并发MAC的患者(n=112)及无MAC的患者(n=64)。Gensini评分评估两组冠状动脉严重程度,并分析冠状动脉严重程度与MAC的关系。结果 MAC组的冠状动脉粥样硬化性心脏病(冠心病)患者检出率高于对照组,但差异无统计学意义(54.5%vs. 48.4%,P=0.441)。MAC组的Gensini评分高于对照组,差异具有统计学意义[(24.35±11.90)分vs.(21.20±8.81)分,P=0.047]。按MAC严重程度分组后,各组冠心病患者检出率比较,差异无统计学意义(P0.05);而重度MAC组的Gensini评分与对照组、轻度MAC组比较,差异具有统计学意义(P=0.012,P=0.031)。Spearman相关分析结果提示,MAC与Gensini评分呈现中度相关(r=0.512,P0.01)。结论 MAC的严重程度与冠状动脉病变严重程度有相关性,能够提供一定的预测价值。     

血清骨因子水平与冠心病患者冠状动脉病变程度相关性研究

目的探讨冠心病患者血清骨保护素(OPG)、骨桥蛋白(OPN)、骨钙素等骨因子水平与冠心病患者冠状动脉病变程度的关系。方法选取西部战区总医院就诊的患者103例,其中冠状动脉造影示血管狭窄程度<50%者50例为对照组,稳定性冠心病患者53例,根据Gensini评分将冠心病患者分为高分组(Gensini评分≥20分)24例和低分组(Gensini评分<20分)29例。收集患者一般临床资料,检测血清OPG、OPN、骨钙素水平。结果 3组HDL-C水平比较,差异有统计学意义(P<0.05)。高分组OPG、OPN水平明显高于低分组和对照组,骨钙素水平明显低于低分组和对照组(P<0.05);低分组骨钙素水平明显低于对照组(P<0.05)。冠心病患者血清OPG、OPN水平与Gensini评分呈正相关(r=0.819,P=0.018;r=0.367,P=0.007),血清骨钙素水平与Gensini评分呈负相关(r=-0.318,P=0.020)。logistic回归分析显示,OPG、OPN是冠心病的危险因素,骨钙素是冠心病的保护因素(P<0.05);OPG、OPN是Gensini评分增高的危险因素,骨钙素是Gensini评分增高的保护因素(P<0.05)。结论稳定性冠心病患者血清OPG、OPN、骨钙素的水平与冠状动脉病变的严重程度密切相关。     

进展与非进展型脑梗死患者CT血管造影及血清C反应蛋白、同型半胱氨酸、纤维蛋白原、D-二聚体水平比较分析

目的比较进展性脑梗死(PCI)与非进展型脑梗死(NPCI)患者头颈部CT血管造影(CTA)及血清C反应蛋白(CRP)、同型半胱氨酸(Hcy)、纤维蛋白原(FIB)、D-二聚体(D-D)水平。方法回顾性分析173例前循环性急性脑梗死患者的临床资料,按病情将患者分为PCI组(56例)与NPCI组(117例),比较两组患者CTA所示头颈部血管狭窄程度、斑块性质;比较两组患者入院时、入院第3天血清CRP、Hcy、FIB、D-D水平。结果 PCI组患者的动脉狭窄发生率(92.9%)显著高于NPCI组(55.6%),头颈部动脉狭窄中重度所占比例显著大于NPCI组,差异有统计学意义(P0.05)。PCI患者不稳定性斑块所占比例、软斑块及混合斑块所占比例均显著高于NPCI组,差异有统计学意义(P0.05)。入院时,两组患者的血清CRP、Hcy、FIB、D-D水平比较差异无统计学意义(P0.05);入院第3天,PCI组患者的血清CRP、Hcy、FIB、D-D水平均显著高于NPCI组,差异有统计学意义(P0.05)。结论 PCI与患者头颈部动脉狭窄程度及斑块的性质密切相关,患者血清CRP、Hcy、FIB、D-D水平早期明显升高,CTA检查及上述血清指标检测结果可作为早期筛查PCI患者的重要依据。     

左心室射血分数正常的急性ST段抬高型心肌梗死患者氨基末端B型利钠肽原水平与冠状动脉病变的关系

目的:探讨左心室射血分数(LVEF)正常的且无明显舒张性心力衰竭症状的急性ST段抬高型心肌梗死(STEMI)患者血浆氨基末端B型利钠肽原(NT-proBNP)浓度与冠状动脉(冠脉)狭窄程度、冠脉病变数量及左前降支病变的关系。方法:收集符合条件的STEMI患者280例,在入院24 h内检测其血浆NT-proBNP浓度,并对其根据Gensini评分系统评估冠脉病变狭窄严重程度,分为Gensini评分30分组(n=94),Gensini评分30~60分组(n=87),Gensini评分60分组(n=99);根据冠脉病变的数量分为单支病变组(n=78)、双支病变组(n=105)及三支病变组(n=97);根据罪犯血管是否为前降支分为前降支组(n=146)和非前降支组(n=134),对各组结果进行比较分析。结果:血浆NT-proBNP浓度Gensini评分60分组显著高于Gensini评分30分组和Gensini评分30~60分组,Gensini评分30~60分组显著高于Gensini评分30分组;冠脉病变的支数越多,血浆NT-proBNP浓度越高(pg/ml,336.90±176.70vs 608.70±331.20 vs 1176.70±492.50);前降支组血浆NT-proBNP浓度高于非前降支组(pg/ml,1199.40±725.00 vs607.40±244.20),上述比较差异均有统计学意义(P0.05)。血浆NT-proBNP浓度与Gensini积分Pearson相关分析显示两者呈正相关(r=0.278,P0.05)。结论:STEMI患者血浆NT-proBNP浓度与冠脉病变严重程度呈正相关,对其三支血管病变及前降支血管是否为罪犯血管具有一定预测价值,常规检测NT-proBNP浓度有助于STEMI患者的危险分层及临床诊疗。     

低密度脂蛋白亚型与冠状动脉病变程度的关系

目的评价Lipoprint Systerm检测的低密度脂蛋白亚型与冠状动脉病变程度的相关性。方法回顾性搜集冠心病患者139例,所有患者应用Lipoprint Systerm对低密度脂蛋白亚型进行定量分析,并行冠状动脉造影检查,计算病变血管支数及Gensini评分,比较血管三支病变组与简单病变组、Gensini评分高分患者与低分患者的临床特征及脂蛋白亚型的差异,通过Logistic回归分析低密度脂蛋白亚型与冠状动脉病变程度的相关性。结果与简单病变组比较,三支病变组低密度脂蛋白(LDL3)、小而密低密度脂蛋白(sdLDL)、sdLDL浓度百分比升高(P0.05),LDL1～2浓度百分比降低(P0.05)。三支病变组高血压、糖尿病比例高(P0.05)。Logistic回归分析显示高血压、糖尿病、糖化血红蛋白(HbA1c)、LDL3、sdLDL、sdLDL浓度百分比与三支血管病变呈正相关,LDL1～2浓度百分比与三支血管病变呈负相关。与Gensini低分组比较,Gensini高分组极低密度脂蛋白(VLDL)、总胆固醇(TC)、非高密度脂蛋白(nonHDL)、甘油三酯(TG)、LDL3、LDL4、LDL6、sdLDL、sdLDL浓度百分比升高(P0.05),LDL1～2浓度百分比降低(P0.05)。Logistic回归分析显示高血压、HbA1c、LDL6、LDL7、sdLDL、sdLDL浓度百分比与Gensini评分呈正相关,LDL1～2浓度百分比与Gensini评分呈负相关。结论 sdLDL及sdLDL浓度百分比与冠状动脉病变程度正相关,LDL1～2浓度百分比与冠状动脉病变程度负相关。     

慢性幽门螺杆菌感染与冠心病相关性的研究

目的探讨慢性幽门螺杆菌(HP)感染与冠心病的关系。方法用酶免疫检测法测定冠心病组(138例)和非冠心病组(95例)血清幽门螺杆菌抗体,确诊慢性幽门螺杆菌感染;同时用散射比浊法测定C-反应蛋白(CRP)、C3、C4及用血液凝固法测定纤维蛋白原(FIB)水平。结果①冠心病组血清HPIgG阳性率明显高于非冠心病组(44.2%和28.4%,P<0.05);②冠心病组中慢性HP感染者CRP、FIB、C3分别明显高于非HP感染者(P<0.001、P<0.001、P<0.01);③慢性幽门螺杆菌感染与高血压、糖尿病、肥胖、吸烟、年龄、性别及冠心病家族史无关。结论慢性HP感染与冠心病相关;HP感染可能通过促进CRP、C3、FIB水平而起作用。     

不同类型冠心病患者血尿酸、纤维蛋白原、低密度脂蛋白和脂蛋白(a)浓度的变化

目的 研究不同类型冠心病患者血尿酸、纤维蛋白原、低密度脂蛋白和脂蛋白(a)浓度的变化及其与冠状动脉病变程度的关系.方法 185例患者包括107例急性冠状动脉综合征患者、30例冠状动脉痉挛患者及48例稳定型心绞痛患者,以31例非冠心病者为对照组.测定血清尿酸、纤维蛋白原、低密度脂蛋白和脂蛋白(a)浓度,冠状动脉病变严重程度用常规冠状动脉造影后计算Gensini积分与病变支数来估计.结果 急性冠状动脉综合征组、冠状动脉痉挛组和稳定型心绞痛组中男性患者血尿酸浓度高于对照组.急性冠状动脉综合征组和稳定型心绞痛组中女性患者血尿酸浓度高于对照组(P<0.05);急性冠状动脉综合征组血纤维蛋白原浓度高于对照组和稳定型心绞痛组(P<0.05).尿酸、纤维蛋白原和低密度脂蛋白与冠状动脉积分显著相关,尿酸、纤维蛋白原与冠状动脉病变支数显著相关.结论 各型冠心病及其严重程度与血尿酸、纤维蛋白原浓度升高有关,血低密度脂蛋白与冠状动脉积分有关.     

冠心病患者血浆CRP、FIB、PAI-1、HCY含量的变化及其意义

目的：探讨C反应蛋白（CRP）、纤维蛋白原（FIB）、纤溶酶原激活抑制物-1（PAI-1）、同型半胱氨酸（HCY）水平的变化与冠心病（CHD）发生、发展的关系;探讨其诊断冠心病,预测稳定型心绞痛发生心血管事件的危险性。方法：入选的80例CHD患者为CHD组,60例健康人为非CHD组,测定两组血浆中的CRP、FIB、PAI-1、HCY水平。出院后的2年内,CHD组中稳定型心绞痛患者发生心血管事件的定为事件组,其余的为非事件组,然后比较两组患者血浆中CRP、FIB、PAI-1、HCY的水平。结果：与非CHD组比较,CHD组血浆CRP、FIB、PAI-1、HCY水平均显著升高（P均〈0.01）。事件组血浆CRP、FIB、PAI-1、HCY水平均较非事件组显著升高（P均〈0.05）。结论：血浆CRP、FIB、PAI-1、HCY水平的升高可以作为诊断CHD,预测稳定型心绞痛发生心血管事件危险性的指标。     

A serum amyloid A and LDL complex as a new prognostic marker in stable coronary artery disease

BACKGROUND: Although some reports have indicated that acute phase proteins such as C-reactive protein (CRP) and serum amyloid A (SAA) can predict the prognosis in patients with acute coronary syndrome, the value of these markers in patients with stable coronary artery disease (CAD) still remains obscure. Therefore, our aim was to determine the prognostic value of inflammatory markers in patients with stable coronary artery disease. METHODS AND RESULTS: We conducted a prospective cohort study in 140 consecutive patients with stable coronary artery disease who had at least one coronary stenosis more than 50% in diameter seen on diagnostic coronary angiography (CAG). We determined serum levels of the SAA/LDL complex as a new marker in addition to CRP and SAA. Serum levels of the SAA/LDL complex were measured by a sandwich enzyme-linked immunosorbent assay (ELISA). End-points were defined as cardiac death, myocardial infarction, cerebral infarction, and coronary revascularization. End-point events occurred in 21 patients (2 death from myocardial infarction, 2 cerebral infarction, and 17 revascularization). Age (year) (OR = 1.14, CI: 1.05-1.25), diabetes mellitus (OR = 3.50, CI: 1.08-11.40), triglyceride (10mg/dl) (OR = 1.12, CI: 1.01-1.23) and SAA/LDL complex (10 microg/ml) (OR = 2.32, CI: 1.05-4.70) were independently related to the events. A reconstitution experiment suggested that the SAA/LDL complex is derived by oxidative interaction between SAA and lipoproteins. CONCLUSIONS: The SAA/LDL complex reflects intravascular inflammation directly and can be a new marker more sensitive than CRP or SAA for prediction of prognosis in patients with stable coronary artery disease.     

hsCRP and HDL effects of statins trial (CHEST): rapid effect of statin therapy on C-reactive protein and high-density lipoprotein levels A clinical investigation

Inflammation contributes to the pathogenesis of coronary heart disease and elevated serum levels of C-reactive protein (CRP) are independently associated with increased coronary risk. This study assessed whether there were differences in the effects on CRP and high-density lipoprotein (HDL) cholesterol levels among patients treated with three common statins. In a prospective, observational study, 80 dyslipidemic adults without evidence of cardiovascular disease were treated with 10 mg atorvastatin (A), 20 mg simvastatin (S), or 40 mg pravastatin (P) daily. CRP and lipid profiles were assayed before and after 12 weeks of therapy; in 21 patients, CRP levels were also measured after 1 and 4 weeks. The three treatment groups experienced comparable reductions in CRP (A: 33%, S: 42%, and P: 30%) and statistically insignificant changes in HDL cholesterol levels. CRP began to decrease after 1 week of treatment, and decreased further at 4 and 12 weeks of therapy. The change in the log-transformed CRP concentration correlated with the change in the log-transformed LDL cholesterol concentration. Subjects had similar baseline CRP levels, lipid profiles, and coronary risk factors. The authors conclude that at doses achieving similar reductions in LDL cholesterol, the three statins were associated with comparable decreases in CRP without significant changes in HDL cholesterol levels. The correlation between the reductions in CRP and LDL cholesterol differs from the findings of other published studies, and should prompt further investigation of the mechanism by which statins reduce CRP.     

冠心病血糖异常患者炎症因子与糖化血红蛋白的关系

目的 探讨冠心痛血糖异常患者血炎症因子特点及其与糖化血红蛋白的关系.方法 对经临床和冠状动脉造影确诊为冠心病的203例患者全部行糖耐量试验,然后按血糖水平分成糖尿病组(68例)、糖调节异常组(80例)及血糖正常组(55例).分析比较三组血白细胞、纤维蛋白原和C反应蛋白水平及其与糖化血红蛋白的关系.结果 糖尿病组和糖调节异常组患者血白细胞、纤维蛋白原和C反应蛋白水平均较血糖正常组升高(均P<0.05).血清糖化血红蛋白水平与血白细胞(R~2=0.158 9,P<0.05)、血清C反应蛋白(R~2=0.228 5,P<0.05)和纤维蛋白原(R~2=0.3024,P<0.05)水平呈正相关趋势.结论 糖尿病和糖调节异常冠心病患者合并更严重的系统性炎症反应.     

Associations between inflammatory markers,traditional risk factors,and complications in patients with type 2 diabetes mellitus

OBJECTIVE: Inflammatory markers predict cardiovascular events in a wide range of patients. Two factors, fibrinogen (FIB) and high-sensitivity C reactive protein (CRP), are currently entering clinical practice as cardiovascular risk predictors. In patients with type 2 diabetes mellitus, we sought to examine the relationship between macrovascular disease, urinary albumin/creatinine ratio (ACR), and FIB or CRP, as well as the relationship of FIB and CRP with traditional risk predictors of these complications of diabetes. METHODS: In 202 consecutive patients with type 2 diabetes mellitus from a diabetes clinic, clinical and biochemical data were obtained and a cross-sectional analysis was performed. RESULTS: Patients with macrovascular disease had higher FIB (P=.02) but not higher CRP. They were older, more likely to have retinopathy or elevated serum creatinine, had higher ACR and lower HDL cholesterol. They were more likely to be treated with statins, beta-blockers, and ASA. Adjustment for statin therapy did not result in significant differences in CRP levels according to macrovascular disease status. Both FIB (P=.01) and CRP (P=.02) were significantly higher in patients with ACR whose values were in the proteinuria range. In multivariate analysis, both FIB (P=.001) and CRP (P=.03) were positively correlated with ACR, but no association was seen between CRP and ACR when FIB was entered in the model. Other factors positively associated with ACR were age, diastolic blood pressure, retinopathy, and hemoglobin A1c (HbA1c). FIB and CRP were strongly correlated (R=.49, P< or =.001) and this effect was independent of statin therapy. CRP was positively associated with body mass index (BMI), serum triglycerides, and sulfonylurea therapy and negatively associated with metformin therapy. Patients on statin therapy had significantly higher FIB and lower CRP. Women on hormone replacement therapy (HRT) had significantly lower FIB and higher CRP. CONCLUSIONS: In patients with diabetes: (1) the two markers, FIB and CRP, are interrelated; (2) FIB is significantly associated with presence of microvascular disease, independent of CRP; (3) CRP is strongly associated with metabolic factors but not with complications of diabetes, independently of FIB; (4) statins and HRT were divergently associated with CRP and FIB as HRT was associated with lower FIB and higher CRP, while statins showed the reverse association; and (5) CRP and FIB provide different information about the characteristics and consequences of diabetes mellitus because of divergent associations with biological indicators and therapeutic agents.     

C-reactive protein and risk of cardiovascular disease in men and women from the Framingham Heart Study

BACKGROUND: Determination of C-reactive protein (CRP) level has been suggested to improve cardiovascular disease (CVD) risk assessment. This study examines the utility of CRP levels to assess CVD risk in a community setting. METHODS: We performed a prospective observational cohort study on a community population sample. A total of 1949 men and 2497 women without CVD from the Framingham Heart Study underwent CVD risk factor assessment. Initial CVD events during 8 years of follow-up were recorded. RESULTS: There were 283 major CVD and 160 major coronary heart disease incident events. Age-, sex-, and multivariable-adjusted analyses generally used CRP level categories of less than 1, 1 to 3, and greater than 3 mg/L. In age- and sex-adjusted models, the traditional risk factors and elevated CRP levels indicated increased risk. The age- and sex-adjusted relative risk (RR) and 95% confidence interval (CI) of CRP level greater than 3 mg/L for major CVD was elevated (RR, 1.60; 95% CI, 1.19-2.14), with evidence of attenuation (RR, 1.22; 95% CI, 0.90-1.66) in multivariable models. The C statistic, a measure of the discriminatory capability of the prediction models, was 0.74 for prediction of major CVD with age and CRP level. In multivariable models that included traditional risk factors, the C statistic was 0.78, a value that was unchanged with the addition of CRP to the multivariable model. Similar relations were noted for major coronary heart disease events. CONCLUSION: Elevated CRP level provided no further prognostic information beyond traditional office risk factor assessment to predict future major CVD and major coronary heart disease in this population sample.     

凝血指标、炎症指标与COVID-19的关系研究

背景 COVID-19病情严重程度与凝血指标、炎症指标异常等存在一定关系。目的探讨凝血指标、炎症指标与COVID-19的关系。方法回顾性选取武汉大学人民医院2020年1—5月收治的COVID-19患者280例作为观察组,根据预后将其分为存活亚组(n=231)和死亡亚组(n=49)。另选取2020年3—9月本院健康体检者120例作为对照组。分别比较观察组与对照组、存活亚组与死亡亚组一般资料、凝血指标[包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)]、炎症指标[包括C反应蛋白(CRP)、降钙素原(PCT)]。采用多因素Cox比例风险回归分析探讨COVID-19患者预后的影响因素,绘制受试者工作特征曲线(ROC曲线)分析凝血指标、炎症指标对COVID-19的诊断价值及其预后的预测价值。结果观察组PT长于对照组,血浆FIB、D-D水平及血清CRP、PCT水平高于对照组(P <0.05)。存活亚组年龄小于死亡亚组,冠心病发生率和血浆FIB、D-D及血清CRP、PCT水平低于死亡亚组,PT短于死亡亚组(P <0.05);多因素Cox比例风险回归分析结果显示:年龄[HR=2.869,95%CI(1.497,5.500)]、冠心病[HR=3.796,95%CI(1.680,8.579)]、PT[HR=2.596,95%CI(1.703,3.957)]、血浆D-D水平[HR=2.289,95%CI(1.473,3.557)]及血清CRP[HR=2.542,95%CI(1.607,4.021)]、PCT[HR=2.596,95%CI(1.724,3.910)]水平是COVID-19患者预后的影响因素(P <0.05)。ROC曲线分析结果显示,PT、血浆FIB水平、血浆D-D水平、血清CRP水平、血清PCT水平诊断COVID-19的ROC曲线下面积(AUC)分别为0.592[95%CI(0.542,0.641)]、0.665[95%CI(0.616,0.711)]、0.680[95%CI(0.631,0.725)]、0.690[95%CI(0.642,0.735)]、0.632[95%CI(0.583,0.680)];PT、血浆D-D水平、血清CRP水平、血清PCT水平预测COVID-19患者预后的AUC分别为0.536[95%CI(0.479,0.596)]、0.593[95%CI(0.533,0.651)]、0.603[95%CI(0.543,0.660)]、0.637[95%CI(0.577,0.693)]。结论年龄、冠心病、PT、血浆D-D水平及血清CRP、PCT水平是COVID-19患者预后的影响因素,而凝血指标、炎症指标对COVID-19诊断及其预后预测并无较大价值。