超敏C反应蛋白对急性ST段抬高心肌梗死患者心脏终点事件的预测价值

目的 评价入院早期血清超敏C反应蛋白(hs-CRP)水平对急性ST段抬高心肌梗死(STEMI)患者主要不良心脏事件(MAcE)的预测价值.MACE是心绞痛、再梗死、心力衰竭和心源性死亡.方法 哈尔滨医科大学2006年6月至2007年5月收治的急性SrEMI患者189例,于发病24 h内采空腹肘静脉血(行介人治疗者于术前采血),分别测hs-CRP、白细胞(WBC)、肌酸激酶及其同工酶(CK及CK-MB)、血脂及血糖,并做超声心动图.根据hs-CRP水平,将患者分为hs-CRP升高组(hs-CRP＞4 mg/L)和正常组(hs-CRP≤4mg/L).随访入选患者MACE.各种潜在危险因素单独或联合时与MACE和死亡的相关性用COX比例风险回归进行单、多变量分析.生存曲线采用kaplan-Meier法,并用时序检验和Breslow检验比较生存曲线.结果 两组平均随访(271.1±136.7)d.hs-CRP升高组MACE发生率明显高于正常组(75%vs.25%,P＜0.01),血WBC、CK及CK-MB显著高于正常组(P值分别为0.002,0.039和0.049).MACE组hs-CRP水平显著高于无MACE组(P＜0.01),死亡组hs-CRP显著高于MACE组(P＜0.01). hs-CRP升高组和正常组存活和无MACE患者的Kaplan-Meier曲线均有显著分离(时序检验P值分别为0.0042和0.0062).多因素分析显示,hs-CRP水平是MACE(艘=1.919,P＜0.05)和死亡(RR=3.067,P＜0.05)的独立风险预测因子.高hs-CRP的老年患者(年龄≥65岁)发生MACE(RR=2.547,P＜0.01)和死亡(RR=4.140,P＜0.01)的风险较高.结论 入院早期血清hs-CRP升高是急性STEMI患者随访期发生MACE和死亡的独立危险预测因子.对血清hs-CRP水平和年龄联合评价提供了一种筛选高危患者的方法.

Prognostic value of serum high-sensitivity C-reactive protein in patients with acute ST-segment elevated myocardial infarction

Objective To assess the predictive value of early determination of high-sensitivity C-reactive protein (hs-CRP) levels at admission in patients with acute ST-elevated myocardial infarction (STEM1). Major ad-verse cardiovascular events (MACE) were angina,re-infarction, cardiac failure and cardiac arrest. Method One hundred and eighty-nine patients with acute STEMI were enrolled in this study. Before intetventional therapy, a peripheral blood sample was collected from the fasting patients within 24 hours after the onset of symptoms for the measurement of serum hs-CRP, white blood cell count (WBCs), creatine kinase (CK), MB iso-enzyme of creatine kinase (CK-MB), blood lipid and blood glucose separately. Meanwhile, color echocardiogram was performed. Pa-tients were divided into two groups according to the serum level of hs-CRP, hs-CRP ＞ 4 mg/L group and hs-CRP= 4 mg/L group. And patients were monitored for the occurrence of MACE. Univariate and multivariate Cox's pro-portional hazard regression analyses were performed to determine the relationship between various potential risk factors alone or in combination and MACE as well as death. Survival curves were plotted by using the Kaplan-Meier method, and the log-rank test and Breslow test were used to compare the survival curves. Results The pa-tients with acute STEM1 were followed-up for a mean of (271.1= 136.7) days doe MACE. The difference in inci-dence of MACE between high and low hs-CRP level groups was obvious (75% vs. 25%, P ＜ 0.01). The meanserum levels of WBCs, CK, and CK-MB in the high hs-CRP level group were higher than those of the low hs-CRPlevel group(P= 0.002,0.039 and 0.049, respectively). The highest serum level of hs-CRP was found in de-ceased patient cohort. The serum level of hs-CRP was higher in patients with MACE compared with those withoutMACE (P ＜ 0.01). Kaplan-Meier plots for overall survivals and MACE-free survivals showed a significant distinctbetween high and low hs-CRP level groups (P= 0.0042 and 0.0062 by log-rank test, respectively). The hs-CRPserum levels were independent risk predictors of MACE (RR= 1.919, P ＜0.05) and death (RR= 3.067, P ＜ 0.05). Patients with high hs-CRP levels and age P 65 years were at higher risk of MACE occurrence (RR=2.547, P ＜ 0.01) and death (RR= 4.140, P ＜ 0.01). Conclusions The serum levels of hs-CRP at admis-sion were independent risk predictors of MACE and death in patients with acute STEMI during the period of follow-up. The evaluation of hs-CRP and age may provide an approach to screening the high-risk patients.