C-Reactive Protein as an Independent Cardiovascular Risk Predictor in HIV+ Patients: A Focused Review of Published Studies.
C-Reactive Protein as an Independent Cardiovascular Risk Predictor in HIV+ Patients: A Focused Review of Published Studies.
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DOI：
10.14740/jocmr3154w
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Geraci SA
中科院分区：
文献类型：
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作者：
Gilotra TS;Geraci SA
感染人类免疫缺陷病毒（HIV+）的患者寿命更长，发生心血管事件（CVEs）的风险更高。常用的预测工具似乎在不同程度上和不同方向上歪曲了他们的CVE风险。将细胞感染、慢性免疫激活和/或全身性炎症的标志物纳入风险模型可能提供更好的预测准确性。在HIV+患者中评估高敏C反应蛋白（hs-CRP）与CVE关系的观察性研究报告了不一致的结果。这项对已发表研究的综述试图确定现有证据是否支持其在稳定的、接受治疗的HIV+患者的新模型中的潜在用途。我们使用“HIV”和“心血管风险”和“CRP”的关键词和组合检索PubMed数据库。纳入了提供原始分析的论文，将hs-CRP浓度作为独立变量与硬心血管结局（心肌梗死和心血管死亡）或硬CVE作为复合终点的一部分相关联。5项观察性研究符合纳入/排除标准。三篇论文确定了hs-CRP升高与CVE之间的关联，而另外两篇论文未能发现任何显著关联。所有报告在自变量、对照和设计方面均为异质性。规模更大、更严格的研究，在其复合材料中采用更高的混杂对照率和更客观的终点，显示出积极的相关性。虽然不是结论性的，但目前的优势证据支持CRP作为HIV+患者前瞻性心血管风险预测研究的潜在有价值因素。
Patients infected with the human immunodeficiency virus (HIV+) are living longer and at heightened risk for developing cardiovascular events (CVEs). Commonly used prediction tools appear to misrepresent their CVE risk to varying degrees and in varying directions. Inclusion of markers of cellular infection, chronic immune activation and/or systemic inflammation into risk models might provide better predictive accuracy. Observational studies assessing the relationship of high-sensitivity C-reactive protein (hs-CRP) to CVE in HIV+ patients have reported inconsistent findings. This review of published studies attempted to determine if the available evidence supports its potential use in new models for stable, treated HIV+ patients. We searched the PubMed database using keywords and combinations of “HIV” AND “cardiovascular risk” AND “CRP”. Papers presenting original analyses, associating hs-CRP concentration as an independent variable to hard cardiovascular outcomes (myocardial infarction and cardiovascular death), or to hard CVE as part of a composite endpoint, were included. Five observational studies met inclusion/exclusion criteria for review. Three papers identified an association between elevated hs-CRP and CVE, while two others failed to find any significant association. All reports were heterogeneous in terms of independent variables, controls, and designs. The larger and more rigorous studies, employing higher rates of confounder controls and more objective endpoints in their composites, showed positive associations. Though not conclusive, the preponderance of the evidence at this time supports CRP as a potentially valuable factor to be studied in prospective cardiovascular risk prediction investigations in HIV+ patients.