冠状动脉介入术后高敏C反应蛋白的变化及其意义

目的　前瞻性研究心绞痛患者经皮冠状动脉介入治疗 (PCI)前后高敏C反应蛋白 (hsCRP)的变化 ,并观察其与术后心性事件的相关性。方法　连续入选行单个原位病变PCI的 30例不稳定性心绞痛 (UAP组 )和 16例稳定性心绞痛 (SAP组 )患者 ,测定术前、术后 2 4、4 8及 72h的hsCRP水平 ,随访术后心性事件 ,观察两者的相关性。结果　(1)UAP组和SAP组术后hsCRP均明显增加 ,UAP组增加幅度明显高于SAP组 (P =0 .0 2 )。 (2 )平均随访 (10 .16±1.76 )个月 ,发生心性事件 12例 (其中UAP组 9例 ,SAP组 3例 ) ,两组心性事件发生率差异无显著性意义 ;UAP组发生心性事件的 9例术后 72h的hsCRP仍保持较高水平 ,而无心性事件的 2 1例则呈下降趋势 ,两者比较差异有显著性意义 (P =0 .0 3)。 (3)应用多因素logistic回归分析发现 ,仅术后hsCRP值、年龄与心性事件显著相关 (RR =1.2 3,P =0 .0 13;RR =1.19,P =0 .0 2 3)。结论　UAP患者PCI术后hsCRP增加幅度明显高于SAP患者 ,在行PCI术后 72h的hsCRP水平持续升高 ,提示术后的不良事件发生率高 ,应加强干预。

The change and significance of C-reactive protein after percutaneous coronary intervention

Objectives To observe the change of plasma level of C-reactive protein(hsCRP) before and after percutaneous coronary intervention (PCI) of angina pectoris patients, and determine the relationship between hsCRP and cardiac events.Methods Thirty unstable angina pectoris (UAP) and 16 stable angina pectoris(SAP) patients who underwent PCI for single original lesion were investigated consecutively. Peripheral blood samples were taken before and 24,48,72 hours after PCI. Cardiac events were followed up.Results 1. The hsCRP plasma levels increased apparently after PCI in both UAP and SAP, and the change in UAP was more significant (P=0.02). 2.Twelve cardiac events occurred during following up for 10.16±1.76 month, 9 in UAP and 3 in SAP, and no difference between the 2 groups (P=0.28). The elevated hsCRP levels persisted until 72 hours after PCI in event group of UAP, but the level descended at that time in non-event groups ( P= 0.03). 3.Logistic regression analysis identified that an increased hsCRP level for 72 hours after PCI and age are independent predictors for cardiac event survival (RR=1.23,P=0.01;RR=1.19,P=0.02).Conclusion The hsCRP level after PCI in UAP was apparently higher than in SAP. Elevated hsCRP plasma level persisting for 72 hours after PCI was related to cardiac events and poor outcome. These results may thereby be useful for identifying the patients who merit aggressive medical treatment.