CAJ | 학술논문

目的探讨中老年急性冠状动脉综合征患者血浆超敏C反应蛋白(hs CRP)水平与全球急性冠状动脉事件注册(GRACE)风险评分的关系,并分析对中老年急性冠状动脉综合征患者远期(5年)发生心血管事件的预测价值. 方法中老年急性冠状动脉综合征患者共138例,根据GRACE积分进行危险分层,将患者分为低危组、中危组及高危组.并根据hs-CRP水平将患者分为Q1～Q4组.患者出院后随访5年,观察患者不良心血管事件的发生情况. 结果经对数转换的hsCRP(lghs CRP)水平GRACE积分高的高危组患者为0.43±0.23,高于中危组0.21±0.04、低危组0.09±0.22(P=0.000).从Q1至Q4组,GRACE积分随着hs-CRP水平升高而升高,Q1:(133.0±43.6)分、Q2:(161.9±60.2)分、Q3:(169.3±52.6)分、Q4:(188.4±47.5)分(P＜0.001).相关分析结果显示,lghs-CRP与GRACE评分呈正相关(r=0.576,P＜0.001).5年随访期间共发生心血管事件96例(69.6％).利用ROC曲线分析血浆hs CRP水平及GRACE评分对中老年急性冠状动脉综合征患者远期心血管事件的预测作用,两者的曲线下面积分别为0.821(95％CI:0.749～0.892,P＜0.001)和0.869 (95％CI:0.801～0.938,P＜0.001).两者预测中老年急性冠状动脉综合征患者远期心血管事件的差异无统计学意义(P=0.237). 结论 hs-CRP和GRACE风险评分呈正相关,能较好地评估中老年急性冠状动脉综合征患者的临床风险.hs-CRP和GRACE风险评分两者均可较准确地预测中老年急性冠状动脉综合征患者远期心血管事件发生风险.
목적 탐토중노년급성관상동맥종합정환자혈장초민C반응단백(hs CRP)수평여전구급성관상동맥사건주책(GRACE)풍험평분적관계,병분석대중노년급성관상동맥종합정환자원기(5년)발생심혈관사건적예측개치. 방법 중노년급성관상동맥종합정환자공138례,근거GRACE적분진행위험분층,장환자분위저위조、중위조급고위조.병근거hs-CRP수평장환자분위Q1～Q4조.환자출원후수방5년,관찰환자불양심혈관사건적발생정황. 결과 경대수전환적hsCRP(lghs CRP)수평GRACE적분고적고위조환자위0.43±0.23,고우중위조0.21±0.04、저위조0.09±0.22(P=0.000).종Q1지Q4조,GRACE적분수착hs-CRP수평승고이승고,Q1:(133.0±43.6)분、Q2:(161.9±60.2)분、Q3:(169.3±52.6)분、Q4:(188.4±47.5)분(P＜0.001).상관분석결과현시,lghs-CRP여GRACE평분정정상관(r=0.576,P＜0.001).5년수방기간공발생심혈관사건96례(69.6％).이용ROC곡선분석혈장hs CRP수평급GRACE평분대중노년급성관상동맥종합정환자원기심혈관사건적예측작용,량자적곡선하면적분별위0.821(95％CI:0.749～0.892,P＜0.001)화0.869 (95％CI:0.801～0.938,P＜0.001).량자예측중노년급성관상동맥종합정환자원기심혈관사건적차이무통계학의의(P=0.237). 결론 hs-CRP화GRACE풍험평분정정상관,능교호지평고중노년급성관상동맥종합정환자적림상풍험.hs-CRP화GRACE풍험평분량자균가교준학지예측중노년급성관상동맥종합정환자원기심혈관사건발생풍험.
Objective To evaluate the correlation between plasma high sensitivity C reactive protein (hs-CRP) level and global registry of acute coronary events (GRACE) scores,and its predictive value for long-term (5 years) cardiovascular events in middle-aged and elderly patients with acute coronary syndrome (ACS).Methods 138 middle aged and elderly patients with ACS were divided into three groups according to GRACE scores:low risk group,middle risk group,high risk group.And based on quartiles of hs-CRP levels,subjects were segregated into 4 groups (Q1 to Q4).All subjects were followed up for about 5 years and adverse cardiovascular disease events were recorded.Results The hs-CRP level was gradually increased along with increasing risk according to GRACE risk stratification (hs-CRP low risk group,0.09 ± 0.22 ; middle risk group,0.21 ± 0.04 ;high risk group,0.43±0.23,P＜0.001).Meantime,GRACE risk scores were gradually increased along with increasing hs-CRP levels from Q1 to Q4 (Q1:133.0 ± 43.6; Q2:161.9 ± 60.2; Q3:169.3±52.6; Q4:188.4±47.5; all P＜0.001).Regression analysis showed that hs-CRP level was positively correlated with GRACE risk scores (r=0.576,P＜0.001).During a follow-up period of about 5 years,96 cardiovascular events were recorded.Receiver operating characteristic(ROC) curve analysis showed that area under the ROC curve (AUC) of hs-CRP was 0.821 (95 ％CI:0.749-0.892,P＜0.001) and AUC of GRACE risk score was 0.869 (95％CI:0.801 0.938,P＜0.001) in the evaluation of the long-term risk of incident cardiovascular events.The differences in prediction of long-term cardiovascular events in middle-aged and elderly patients with ACS were not significant (P =0.237) between GRACE risk score and hs CRP level.Conclusions Plasma hs-CRP level is positively associated with GRACE score.Both of them can predict long-term adverse cardiovascular events in middle-aged and elderly patients with acute coronary syndrome.