C-反应蛋白、内皮功能变化与急性冠状动脉综合征相关性研究

目的　探讨 C-反应蛋白及肱动脉流量介导的血管舒张在急性冠状动脉综合征中的变化及其相关性。方法　急性冠状动脉综合征 (ACS)组 5 1例 ,其中急性心肌梗死 (AMI) 15例 ,不稳定性心绞痛 (U AP) 36例 ;选择 2 2例冠状动脉造影除外冠心病的患者为对照组。用速率散射比浊法测血清 C-反应蛋白 (CRP) ,用高分辨率超声测肱动脉反应性充血引起的流量介导血管扩张 (FMD)与硝酸甘油介导的血管扩张 (NTG)。结果　 ACS组 CRP高于对照组(0 .94± 1.45 mg/ dl vs0 .2 7± 0 .2 1mg/ dl,P<0 .0 5 ) ,AMI亚组 CRP明显高于 UAP亚组与对照组 (1.6 4± 1.82mg/ dl vs0 .6 5± 1.17m g/ dl、 0 .2 7± 0 .2 1m g/ dl,P<0 .0 5 ) ,UAP亚组高于对照组 (0 .6 5± 1.82 m g/ dl vs0 .2 7±0 .2 1m g/ dl,P>0 .0 5 )。ACS组的 FMD明显低于对照组 (4 .6 1± 2 .2 1mm vs9.2 3± 3.45 mm,P<0 .0 5 ) ,而 NTG与对照组比较则无差别。经 logisitic回归分析 ,CRP的风险比值 (OR)值大于 1,是 ACS的危险因素 ,FMD的 OR值小于 1,是 ACS的保护因素。经前进法观察 CRP与 FMD在急性冠脉综合征中的作用是相互独立的。结论　急性冠状动脉综合征患者 C-反应蛋白升高 ,内皮功能受损 ,二者是 ACS发生的独立危险因素

Relation of C-reactive protein and endothelial dysfuction to acute coronary syndrome

Objective To study the relation of c-reactive protein (CRP)and flow-mediated vasodilation (FMD) with acute coronary syndrome(ACS) patients. Methods The ACS group include 51 patients, which were composed of AMI subgroup(15 patients) and UAP subgroup(36 patients) , the control group were 22 subjects who had normal coronary angiograms. All of them were measured serum C-reactive protein by using velocity scatter turbidimetric method. Using high resolution ultrasound, We measured their brachial arterial hyperemia induced flow mediated vasodilation (FMD) and sublingual nitroglycerin(NTG) mediated vasodilation to assess endothelium-dependent vasodilation and endothelium-independent vasodilation. Results Serum C-reactive protein was higher in ACS group compared with control(0.94±1.45mg/dl vs 0.27±0.21 mg/dl,P< 0.05), which of AMI subgroup was higher than UAP subgroup(1.64±1.82 mg/dl vs 0.65±1.17 mg/dl, and 0.27±0.21 mg/dl,P< 0.05). The FMD in ACS group was significantly decrease contrast to control group(4.61±2.21 mm vs 9.23±3.45mm,P< 0.05),but NTG had not significantly difference between the two groups. By Logistic regression, the odds ratio (OR) of CRP was > 1,that means CRP is a risk factor; the OR of FMD was <1,that means FMD is a protect factor. With forward method , the result indicates the effect of CRP and FMD is independent in the course of ACS. Conclusion The serum CRP was increased in ACS, and the patients had significant endothelial dysfunction. CRP and endothelial dysfunction was independent risk factor of ACS.