C-reactive protein and other inflammatory risk markers in acute coronary syndromes
C-reactive protein and other inflammatory risk markers in acute coronary syndromes
复制标题
DOI：
10.1016/s0735-1097(02)02953-4
复制
发表时间：
2003-02-19
影响因子：
24
通讯作者：
Ridker, PM
中科院分区：
文献类型：
--
作者：
Blake, GJ;Ridker, PM
心肌细胞坏死的标志物，如心肌肌钙蛋白或肌酸激酶-心肌带是急性冠脉综合征（ACS）患者危险分层的宝贵工具。尽管如此，许多没有任何肌细胞坏死证据的患者可能具有复发性缺血事件的高风险。考虑到炎症过程在决定斑块稳定性中的重要作用，最近的工作集中在炎症的血浆标志物是否有助于改善危险分层。在这些标志物中，C反应蛋白（CRP）已被最广泛的研究，现在有强有力的证据表明，CRP是一个强有力的预测心血管风险的明显健康的个人，病人接受择期血运重建手术，并提出与ACS。此外，即使在肌钙蛋白阴性的ACS患者中，CRP水平升高也可预测未来的风险。其他炎症级联反应的上游标记物，如白细胞介素（IL）-6，也被发现可预测复发性血管不稳定。来自冠状动脉疾病不稳定试验研究人员的第二份FRagmin的最新报告表明，炎症标志物（如IL-6）水平的升高可能表明哪些患者可能从早期侵入性策略中获益最多。目前正在研究的其他炎症标志物包括脂蛋白相关磷脂酶A（2）、髓过氧化物酶和妊娠相关血浆蛋白A。在所有这些新的标志物中，CRP似乎符合潜在临床应用所需的大多数标准。此外，改变生活方式和阿司匹林或他汀类药物治疗的益处可能在CRP水平升高的患者中最为显著。(C)2003年由美国心脏病学会基金会。
Markers of myocyte necrosis such as cardiac troponin or creatine kinase-myocardial band are invaluable tools for risk stratification among patients presenting with acute coronary syndromes (ACS). Nonetheless, many patients without any evidence of myocyte necrosis may be at high risk for recurrent ischemic events. In consideration of the important role that inflammatory processes play in determining plaque stability, recent work has focused on whether plasma markers of inflammation may help improve risk stratification. Of these markers, C-reactive protein (CRP) has been the most widely studied, and there is now robust evidence that CRP is a strong predictor of cardiovascular risk among apparently healthy individuals, patients undergoing elective revascularization procedures, and patients presenting with ACS. Moreover, even among patients with troponin-negative ACS, elevated levels of CRP are predictive of future risk. Other, more upstream markers of the inflammatory cascade, such as interleukin (IL)-6, have also been found to be predictive of recurrent vascular instability. A recent report from the second FRagmin during InStability in Coronary artery disease trial investigators suggests that elevated levels of an inflammatory marker such as IL-6 may indicate which patients may benefit most from an early invasive strategy. Other inflammatory markers currently under investigation include lipoprotein-associated phospholipase A(2), myeloperoxidase, and pregnancy-associated plasma protein A. Of all these novel markers, CRP appears to meet most of the criteria required for potential clinical application. Furthermore, the benefits of lifestyle modification and drug therapy with aspirin or statins may be most marked among those with elevated CRP levels. (C) 2003 by the American College of Cardiology Foundation.