【摘要】 目的:分析414例冠心病患者基线C反应蛋白(CRP)水平及对冠状动脉血管重建预后的最佳预测切点。方法:本研究为单中心回顾性研究,入选了北京安贞医院冠心病接受血管重建患者414例,应用ROC曲线分析方法判定CRP最佳切点,比较不同基线C反应蛋白水平患者长期随访的临床结果,中位随访时间为551d。结果:ROC曲线分析CPR5.5mg/L为最佳切点,Cox回归分析,只有CRP对随访主要不良心脑血管事件(MACCE)差异有统计学意义,高CRP组无事件发生率显著少于低CRP组(log-rank,P<0.001)。结论:基线C反应蛋白水平是冠心病血管重建患者预后的独立预测因子,基线CRP5.5mg/L可能是冠心病患者作为判断冠状动脉血管重建后长期预后不良的最佳切点。更多还原

【Abstract】 Objective:C-reactive protein(CRP) is one of the body’s inflammatory response factors.The epidemiological data support that CRP correlates with adverse cardiovascular events.In particular,the most appropriate cut point for CRP and the prognostic significance of those cut point in different population remains unclear.The study aimed to determine the optimal cut-off point of baseline C-reactive protein for the prognostic prediction of Chinese patients undergoing coronary revascularization.Methods:This study is a retrospective registered study from a single center.The study has enrolled 414 patients who underwent coronary revascularization from July 2003 to September 2005 in Beijing Anzhen Hospital.All patients received aspirin or clopidogrel for anti-platelet aggregation,and the dosage of β-Blocker and statins were adjusted individually to the target dose.Revascularization includes stent implantation and coronary artery bypass grafting surgery(CABG).Demographic data,clinical features,laboratory test results,revascularization information were recorded.The telephone follow-ups were done according to a pre-designed questionnaire,all the collected data were input into computer databases.The median follow-up time was 551 days.The major adverse cardiovascular and cerebral events(MACCE) include death,acute myocardial infarction,stroke and re-revascularization.The receiver-operating characteristics(ROC) curve analysis was performed to determine the optimal cut-off point of CRP.Cox regression and Kaplan-Meier analysis were used for evaluate the long-term clinical outcomes between high level CRP group and low level one.Results:By ROC curve analysis,the CRP optimal cutoff point is 5.5 mg/L.With CRP 5.5 mg /L as the cutoff point,the study population was divided into two groups,low-CRPgroup(CRP ≤5.5 mg /L) 266 people,the high CRP group(CRP > 5.5 mg /L) 148 people.With the covariates as history of hypertension,diabetes,family history of early-onset coronary heart disease,smoking,male,and the differences in baseline factors such as age,peripheral angiopathy,diagnosis,left ventricular ejection fraction(LVEF),white blood cell count(WBC),Hemoglobin(HGB),Glomerular filtration rate(GFR),high density lipoprotein cholesterol(HDL-C),medication,forward stepwise(Conditional LR) method was applied in Cox regression analysis.Cox regression analysis shown only CRP level could contribute to the major adverse cardiovascular and cerebral events(MACCE) during the follow-up.Kaplan-Meier analysis indicated that MACCE-free incidence with the high CRP group was significantly lower than those with the low CRP group(log-rank,P < 0.001).Conclusions:Baseline CRP levels of the patients with coronary revascularization is still an independent predictor for long-term follow-up adverse cardiovascular and cerebrovascular events.CRP 5.5 mg/L may be the most appropriate cutoff point for Chinese people to evaluate its prognostic value.The coronary heart disease patients with CRP > 5.5 mg/L have much higher risk for longterm follow-up MACCE.更多还原