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BMJ Open Heart:高敏C反应蛋白可作为轻度中度主动脉瓣狭窄患者降脂的预后指标

2015-02-12 梁怀彬 译 MedSci原创

在“辛伐他汀、依泽替米贝在主动脉狭窄中应用”实验(Simvastatin and Ezetimibe in Aortic Stenosis ,SEAS)中,为了评估轻到重度主动脉瓣狭窄的患者在使用上述药物或安慰剂后高敏C反应蛋白在患者的预后的预测价值。研究人员对SEAS中1620个患者进行了分组研究。    在1620个SEAS患者中,研究者测量了他们的血脂

在“辛伐他汀、依泽替米贝在主动脉狭窄中应用”实验(Simvastatin and Ezetimibe in Aortic Stenosis ,SEAS)中,为了评估轻到重度主动脉瓣狭窄的患者在使用上述药物或安慰剂后高敏C反应蛋白在患者的预后的预测价值。研究人员对SEAS中1620个患者进行了分组研究。
    



在1620个SEAS患者中,研究者测量了他们的血脂和高敏C反应蛋白的基线水平,并在治疗一年后再次测量并记录。在之后的四年内,研究者对这1620个患者人进行了随访,并针对这些患者在四年内的主要心血管事件(MCE)包括缺血性心血管事件(ICE)和主动脉瓣相关事件(AVE)的发生情况进行记录。

研究者将这些患者进行临床分组,其中服用辛伐他汀/依折麦布这一组的患者,在治疗的第一年,低密度脂蛋白从治疗前的3.49(95%CI 2.94-4.15)降到了1.32(95%CI 1.02-1.69)mmol/L、高敏C反应蛋白从2.1(95%CI 0.9-4.1)降至1.2(95%CI 0.6-2.4)mg/L;而服用安慰剂的那一组患者的低密度脂蛋白从治疗前的3.46(95%CI 2.92-4.08)降至到3.34(95%CI 2.81-3.92)mmol/ L,高敏C反应蛋白从2.2(0.9-4.9)降至1.8(0.85-4.35)mg / L,对照组和用药组的低密度脂蛋白和高敏C反应蛋白的P值均<0.05,具有统计学意义。

在多变量Cox回归分析中,调整传统的危险因素和C反应蛋白的基线水平后,发现了缺血性心血管事件的发生与高敏C反应蛋白 (HR=1.19 (95%CI 1.12 to 1.25)增加一年但未予积极治疗(HRTreatment=0.86 (0.67 to 1.13), p=0.28).相关。这些患者中高敏C反应蛋白基线排在前四分之一的人与剩下的四分之三的患者的差别是他们都是有着更显著的心血管事件( (HR=1.34(1.09 to 1.64), p=0.02)高危因素。

研究者发现,不管患者的高敏C反应蛋白的基线是高的程度如何,其浓度降低都标示着一年后着显著的预后改善。因此,这一发现否定了高敏C反应蛋白基线的高低影响着心血管事件的发生率这一说法。

最终研究者得出结论:缺血性心血管事件发生的减少有一部分是和高敏C反应蛋白的降低有关而并不是人们一贯认为的脂类。高敏C反应蛋白的减少和心血管事件发生率的降低相关,这在那些高敏C反应蛋白基线较高的病人尤其显著。

SEAS注册:NCT00092677.

原始出处:

Adam Blyme, Camilla Asferg, Olav W Nielsen, Thomas Sehestedt, Y Antero Kesäniemi, Christa Gohlke-Bärwolf, Kurt Boman, Ronnie Willenheimer, Simon Ray, Christoph A Nienaber, Anne Rossebø, Kristian Wachtell, Michael H Olsen.High sensitivity C reactive protein as a prognostic marker in patients with mild to moderate aortic valve stenosis during lipid-lowering treatment: an SEAS substudy.Open Heart 2015;2:1 e000152 doi:10.1136/openhrt-2014-000152 

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    2015-03-04 gaoxiaoe
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    2015-03-05 feather89
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    2015-02-17 chinayinhan

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  4. 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content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355966, encodeId=9f9713559665f, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374165, encodeId=c0e313e41653f, content=<a href='/topic/show?id=8de610018644' target=_blank style='color:#2F92EE;'>#预后指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100186, encryptionId=8de610018644, topicName=预后指标)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca3c375, createdName=jwf_2001, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1414992, encodeId=64a5141499205, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=)]
    2015-02-16 windmilL1989

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1847646, encodeId=90a5184e64607, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Wed Mar 04 04:33:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1725750, encodeId=e36f1e25750dc, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, 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content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355966, encodeId=9f9713559665f, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374165, encodeId=c0e313e41653f, content=<a href='/topic/show?id=8de610018644' target=_blank style='color:#2F92EE;'>#预后指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100186, encryptionId=8de610018644, topicName=预后指标)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca3c375, createdName=jwf_2001, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1414992, encodeId=64a5141499205, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=)]
    2015-02-15 223.104.5.**

    高敏CRP可能有一定优势

    0

  6. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374165, encodeId=c0e313e41653f, content=<a href='/topic/show?id=8de610018644' target=_blank style='color:#2F92EE;'>#预后指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100186, encryptionId=8de610018644, topicName=预后指标)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca3c375, createdName=jwf_2001, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1414992, encodeId=64a5141499205, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=)]
  7. 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  8. 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encodeId=46571545238, content=高敏CRP可能有一定优势, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=223.104.5.**, createdTime=Sun Feb 15 12:35:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1297805, encodeId=58b1129e80505, content=<a href='/topic/show?id=4eca5598c7' target=_blank style='color:#2F92EE;'>#C反应蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5598, encryptionId=4eca5598c7, topicName=C反应蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=20b5274, createdName=JR19860219, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332367, encodeId=4e49133236e7c, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355966, encodeId=9f9713559665f, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374165, encodeId=c0e313e41653f, content=<a href='/topic/show?id=8de610018644' target=_blank style='color:#2F92EE;'>#预后指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100186, encryptionId=8de610018644, topicName=预后指标)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca3c375, createdName=jwf_2001, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1414992, encodeId=64a5141499205, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=)]
    2015-02-14 zhaojie88
  9. 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content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355966, encodeId=9f9713559665f, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, 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createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=)]
  10. 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createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Sat Feb 14 05:33:00 CST 2015, time=2015-02-14, status=1, ipAttribution=)]

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