CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease - Application to Clinical and Public Health Practice - Clinical use of inflammatory markers in patients with cardiovascular diseases - A background paper
CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease - Application to Clinical and Public Health Practice - Clinical use of inflammatory markers in patients with cardiovascular diseases - A background paper
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DOI：
10.1161/01.cir.0000148983.88334.80
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发表时间：
2004-12-21
期刊：
影响因子：
37.8
通讯作者：
Biasucci, LM
中科院分区：
文献类型：
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作者：
Biasucci, LM
炎症是公认的急性冠状动脉综合征的关键组成部分。这种发病机制的成就导致使用炎症细胞和蛋白质作为这些综合征的预后标志物。已经提出了许多标记物，包括促炎细胞因子，例如白细胞介素6、白细胞介素-1RA和肿瘤坏死因子-α，粘附分子，例如细胞内粘附分子-1和血管粘附分子-1以及细胞活化标志物。尽管所有这些都具有科学意义，但这些标记物的临床使用因其高成本、低可用性和不利的生物学特征而受到限制。相反，常见的炎症标志物，如 C 反应蛋白 (CRP)、原型急性期蛋白以及较小程度的纤维蛋白原，已被证明是缺血性心脏病风险的可靠且重要的标志物。尤其是 CRP，已被发现与急性冠状动脉综合征（包括 ST 段抬高型心肌梗死和稳定型心绞痛）的短期和长期预后相关，并可预测血运重建手术后再狭窄和包括死亡在内的重大事件的风险。人们一致发现，CRP 独立于其他风险因素，并且具有超出常见风险因素和风险生化标志物（包括肌钙蛋白）的增量价值。 CRP 是否也应该用作治疗指南仍然是一个值得进一步、适当设计的研究的讨论问题。
Inflammation is a recognized key component of acute coronary syndromes. Such pathogenetic achievement has led to the use of inflammatory cells and proteins as prognostic markers in these syndromes. A number of markers have been proposed, including proinflammatory cytokines such as interleukin-6, interleukin-1RA, and tumor necrosis factor-alpha, adhesion molecules such as intracellular adhesion molecule-1 and vascular adhesion molecule-1 and markers of cell activation. Although all are of scientific interest, the clinical use of these markers is limited by their high cost, low availability, and unfavorable biological profile. Conversely, common markers of inflammation such as C-reactive protein (CRP), the prototypic acute phase protein, and to a lesser extent fibrinogen, have been proven to be reliable and important markers of risk in ischemic heart disease. CRP, in particular, has been found to be associated with short- and long-term prognosis in acute coronary syndromes, including ST-elevation myocardial infarction, and in stable angina, and to predict the risk of restenosis and major events, including death, after revascularization procedures. CRP has been consistently found to be independent from other risk factors and to have an incremental value beyond the common risk factors and biochemical markers of risk, including troponin. Whether CRP also should be used as a guide to therapy is still a matter of discussion that deserves further, properly designed studies.