全球精选文摘 - 急性冠脉综合征后30天的C反应蛋白和B型利钠肽浓度可独立预测心力衰竭患者住院和心血管源性死亡

Concentrations of C-Reactive Protein and B-Type Natriuretic Peptide 30 Days after Acute Coronary Syndromes Independently Predict Hospitalization for Heart Failure and Cardiovascular Death

Scirica BM, for the PROVE IT–TIMI 22 Investigators 2009/10/10 12:21:37

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Clin Chem, 2009,

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Background:
Heart failure (HF) is an important cause of morbidity in patients with acute coronary syndromes (ACS). C-reactive protein (CRP) has been implicated in experimental models as exacerbating myocardial injury, but data regarding the clinical relationship of high-sensitivity CRP (hsCRP) and B-type natriuretic peptide (BNP) concentrations with the risk of HF after ACS are few.

Methods:
PROVE IT–TIMI 22 randomized 4162 patients who had been stabilized after ACS to either intensive or moderate statin therapy. hsCRP and BNP were measured 30 days after randomization. Hospitalizations for HF and cardiovascular death occurring after day 30 were assessed for a mean follow-up of 24 months.

Results:
Patients who developed HF had higher concentrations of hsCRP (3.7mg/Lvs 1.9mg/L, P<0.001) and BNP (59ng/L vs 22ng/L, P<0.0001). HF increased in a stepwise manner with hsCRP quartile [adjusted hazard ratio (HRadj) for Q4 vs Q1, 2.5; P=0.01] and BNP quartile (HRadj for Q4 vs Q1, 5.8; P<0.001), with similar results obtained for HF and cardiovascular death. In a multivariable analysis, higher concentrations of hsCRP and BNP were both independently associated with HF [HRadj, 1.9 for hsCRP >2.0mg/L (P=0.01) and 4.2 for BNP >80ng/L (P<0.001)]. Patients with increases in both markers were at the greatest risk of HF, compared with patients without an increased marker concentration (HRadj, 8.3; P=0.01). The benefit of intensive statin therapy in reducing HF was consistent among all patients, regardless of hsCRP or BNP concentration.

Conclusions:
Both hsCRP and BNP measured 30 days after ACS are independently associated with the risk of HF and cardiovascular death, with the greatest risk occurring when both markers are increased.

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高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭

病例分析 [栏目介绍]

呼吸急促伴精神状态改变——《西氏内科学》病例

摘自：《西氏内科学》，第23版

患者男性，36岁，幼年有吸入性肺损伤史，因呼吸急促和精神状态改变来我院就诊。患者睡眠和运动时，吸氧流量基值为2 L/min，每天均进行肺功能康复训练。患者居住在美国中西部，入院5天前曾离家乘船来这里看望其兄弟。入院前一天，患者呼吸急促加剧，自觉发热并注意到其慢性咳嗽稍加重，但痰液无变化。当天晚上，家人注意到患者更加急躁并有点偏执。由于症状加重，患者于次日送我院就诊。

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