C反应蛋白与心率恢复对糖尿病患者心血管事件的预测

目的:评价高敏C反应蛋白(hsCRP)水平与活动平板运动试验心率恢复(HRR)对2型糖尿病患者新发心血管事件的预测作用。方法:检测156例2型糖尿病患者血清hsCRP,根据检测结果分为hsCRP正常组、hsCRP异常组;再于当日或一周内行活动平板运动试验,根据运动后HRR情况分为HRR正常组、HRR异常组;并根据血清hsCRP正常、异常和HRR正常、异常进行交叉组合分成4组:Ⅰ组为hsCRP正常、HRR正常,Ⅱ组为hsCRP正常、HRR异常,Ⅲ组为hsCRP异常、HRR正常,Ⅳ组为hsCRP异常、HRR异常。每半年收集1次新发心血管事件的情况,随访2年～3年。结果:1、发生心血管事件52例,总发生率33.3%。2、hsCRP正常组、异常组心血管事件发生率分别为16.4%和46.1%,两者间有显著差异;将hsCRP异常作为预测标准,其相对危险度为2.8。3、HRR正常组、异常组心血管事件发生率分别为3.2%和53.8%,两者间有显著差异;将HRR异常作为预测标准,其相对危险度为16.9。4、Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组的心血管事件发生率分别为2.9%、31.3%、3.6%、65.6%,4组间有显著差异。其中,Ⅰ组与Ⅲ组间无显著差异,Ⅰ组、Ⅲ组与Ⅱ组、Ⅳ组间差异有统计学意义;Ⅱ组与Ⅳ组间有显著差异。Ⅱ组、Ⅲ组、Ⅳ组相对于Ⅰ组的相对危险度分别是10.9、1.3、23。结论:HRR异常及hsCRP异常均是糖尿病患者发生心血管事件的风险预测指标,且HRR异常的预测价值更高;联合应用hsCRP与HRR两项指标对糖尿病患者进行心血管事件的筛查,可进一步提高对风险评估的准确率,对糖尿病患者心血管事件的预测具有重要的临床意义。

C-reactive protein and heart rate recovery predicts cardiovascular events in patients with diabetes mellitus

Objective:To evaluate the predictive value of high sensitive C-reactive protein and heart rate recovery on the new cardiovascular events in the patients with Type 2 Diabetes Mellitus.Methods:To assay high sensitive C-reactive protein in 156 patients with Type 2 Diabetes Mellitus who performed exercise stress test at the same time or in one week.The subjects were divided into normal hsCRP and abnormal hsCRP group and normal HRR and abnormal HRR group based on the results.Then according to the value of hsCRP and HRR,the diabetics were subdivided cross-over into 4 groups:GroupⅠ with normal hsCRP and HRR,GroupⅡ with normal hsCRP and abnormal HRR,GroupⅢ with abnormal hsCRP and normal HRR,GroupⅣ with abnormal hsCRP and abnormal HRR.The new cardiovascular events were counted every half year in the follow-up 2 or 3 years.Results:1.52 of 156 patients had new cardiovascular events.The total incidence of events was 33.3%.2.The incidence of cardiovascular events in normal hsCRP and abnormal hsCRP group were 16.4% and 46.1% respectively,there was a significant difference between the two groups.Based on the value of hsCRP,the relative risk value was 2.8;3.The incidence of cardiovascular events in normal HRR and abnormal HRR group were 3.2% and 53.8% respectively,there was a significant difference between the two groups too.To regard abnormal HRR as the predictor,the relative risk level was 16.9;4.The occurrence rates of cardiovascular events in GroupⅠ,GroupⅡ,GroupⅢ,GroupⅣ were 2.9%,31.3%,3.6%,65.6% respectively,there was a significant difference among the 4 groups.Thereinto,there was no significant difference between groupⅠ and groupⅢ,while there was a significant difference between groupⅡ and Ⅳ.The incidence of events was statistically significant among groupⅠ,groupⅢ and group Ⅱ,and also among groupⅠ,groupⅢ and group Ⅳ;compared with groupⅠ,the relative risk values of group Ⅱ,groupⅢ,group Ⅳ were 10.9,1.3,23 respectively.Conclusion:Both abnormal HRR and abnormal hsCRP are predictors of cardiovascular risk in diabetics while the indicative value of HRR is much higher;Combining HRR with hsCRP can improve the accuracy of risk assessment on screening cardiovascular risk in diabetics,which is of clinical significance.