急性冠脉综合征后炎症标志物、死亡危险及再发非致死性冠状动脉事件

目的 急性冠状动脉综合征中,C-反应蛋白（CRP）与后续死亡强相关,其他的生物学标志物可能反映不同的疾病过程.本研究评估炎症和血管标志物与急性冠状动脉综合征后16周内死亡危险及再发非致死性心血管事件的关系.方法 选择300例急性冠状动脉综合征患者,24～96 h检测血液C-反应蛋白（CRP）、血清淀粉蛋白A（SAA）、白细胞介素-6（IL-6）、可溶性细胞间黏附分子（ICAM）、可溶性血管细胞黏附分子（VCAM）、E-选择素、p-选择素和组织纤维蛋白激活抗原（tPA）,并进行相关分析.结果 采用Cox比例危险模型分析显示,基础值CRP（P=0.006）、SAA（P=0.012）、IL-6（P＜0.001）和死亡危险相关,而与再发非致死性急性冠状动脉事件无关;VCAM和tPA与死亡危险（P＜0.001,P=0.021）及非致死性急性冠状动脉事件相关（P=0.021,P=0.049）.结论 急性冠状动脉综合征患者的CRP炎症介质与急性冠状动脉综合征后死亡危险相关,可能反映心肌损伤;VCAM和tPA对于反映炎症和血栓事件具有更大的特异性,可预示再发性冠状动脉事件.

Inflammatory markers,risk of mortality and non-fatal coronary events after acute coronary syndrome

Objective In patients with acute coronary syndrome, C-reactive protein （CRP） strongly relates to subsequent death, other biomarkers may reflect differences in the disease process. We assessed inflammato- ry and vascular biomarkers and the risk of death and recurrent nonfatal cardiovascular events in the 16 weeks after an acute coronary syndrome. Methods Of 300 patients 24 to 96 hours after presentation with acute coronary syndrome were measured blood concentrations of CRP, serum amyloid A （SAA）, interleukin-6 （IL-6）, soluble intercellular adhesion molecule（ICAM）, soluble vascular cell adhesion molecule（VCAM）, E-selectin, P-selectin, and tissue plasminogen activator antigen（tPA） and correlation analysis was evaluated. Results Biomarkers were related to the risk of death, and recurrent nonfatal acute coronary syndromes （myocardial infarction or unstable angina） over 16 weeks using Cox proportional hazard models. On univariate analyses, baseline CRP（P=0.006）, SAA（P= 0.012）, and IL-6（P〈0.001 ） were related to death, but not to recurrent nonfatal acute coronary syndromes. VCAM and tPA related to the risk of death （P〈0.001, P=0.021, respectively） and to nonfatal acute coronary syndromes （P=0.021, P=0.049, respectively）. Conclusion In acute coronary syndromes, the CRP inflammatory factor relates to the risk of death and may reflect myocardial injury. VCAM and tPA may have greater specificity for processes reflecting inflammation and thrombosis in the epicardial arteries, which determine recurrent coronary events.