[TCT2008]生物标记物在临床心血管疾病危险分层中的作用

发布于:2008-10-15 21:26

韩玮，医学博士，心内科主治医师，发表论文10余篇，主要从事心血管疾病介入治疗

Hanwei, attending physician in Cardiology department of the General Hospital of Chinese Armed Police Forces, doctor degree in PLA General Hospital. Be proficiency in transradial coronary artery disease interventional therapy, IVUS and Multi-slice computed tomography coronary artery imagination, published 14 articles and 3 books recent years.

生物标记物在临床心血管疾病危险分层中的作用

Biomarkers Help Stratify Risk in Clinical Disease

（北京武警总医院韩玮翻译）

生物标记物能筛查无症状的亚临床疾病患者，并对这些患者进行危险分层，马萨诸塞医学院的James H. Chesebro在TCT大会上指出，生物标记物在和斑块增殖和破裂相关的心血管疾病的预测、诊断和治疗中都有重要作用。

C反应蛋白是和心血管疾病和不良事件相关的急性期反应蛋白，CRP有助于对心血管疾病患者进行危险分层。

Chesebro在周一指出，“C反应蛋白能评价心血管疾病的进展或心脏不良事件的，CRP 也能预测梗死后表现为急性冠脉综合征的不稳定性心绞痛患者的危险性，以及象心肌梗死、心血管死亡、卒中或周围血管疾病的危险。”CRP也是不良生活模式的指示物，肥胖、吸烟、糖尿病、缺乏规律运动的人有更高的CRP水平，而这一升高预示代谢紊乱综合征危险的增加。

CRP水平1mg/L预示低度心血管危险，1-3mg/L预示中度危险，而3mg/L以上预示高度危险。女性中很低（0.5mg/L）或极低（0.1mg/L）也提示心肌梗死、卒中或心血管死亡的风险增加。

CD-40配体

Chesebro强调了CD-40配体的作用，CD-40是炎症反应的介质和危险指标，GP IIb/IIIa抑制剂能抑制CD-40的释放。

生物标记物也能评价糖尿病的危险性，多种心血管危险因素能增加斑块形成、斑块破裂和血栓的危险，这些相互作用的危险因素也能增加心血管事件和CRP水平，吸烟能导致血管收缩、增加CRP水平和缩短在体血小板的存活时间。“实际上生物标记物能帮助我们进行危险因素的干预，尤其是CRP在我们需要进行最佳控制的危险因素中有重要作用。”

（来源：www.tctmd.com）

Biomarkers Help Stratify Risk in Clinical Disease

Key Points:

• CRP level may indicate increased risk of CV events.

By TCT Daily Staff

Biomarkers are useful for screening preclinical disease in asymptomatic patients and can help stratify risk in patients with clinical disease.

James H. Chesebro, MD, professor of medicine at the University of Massachusetts Medical School and Memorial Hospital in Worcester, explained the utility and importance of biomarkers in predicting, diagnosing, and treating cardiovascular diseases associated with plaque proliferation and rupture.

C-reactive protein is a sensitive acute-phase reactant that is associated with increased risk for CV disease and events. Using CRP levels to risk stratify patients can be helpful in predicting cardiovascular risk in those with and without overt cardiovascular disease, Chesebro said.

Multiple CV risks

"C-reactive protein assesses risk of developing cardiovascular disease or experiencing an event in the absence of noncardiac problems," Chesebro said Monday. "CRP also helps predict risk in patients with stable angina presenting with acute coronary syndrome post-infarction, as well as multiple cardiovascular risks like MI, cardiovascular death, stroke, peripheral arterial disease, and restenosis."

CRP also can be indicative of a "decadent lifestyle," he said. Patients who are obese, smoke, have diabetes, and do not exercise regularly are likely to have elevated CRP levels. These elevated levels can indicate increased risk of metabolic syndrome.

CRP levels ,1 mg/L denote low cardiovascular risk, 1 mg/L to 3 mg/L denote intermediate risk, and .3 mg/L denote high risk.

In women, very low (,0.5 mg/L) or very high (.10 mg/L) CRP levels denote different cardiovascular relative risks for MI, stroke, coronary revascularization, or cardiovascular death.

CD-40 ligand

Chesebro highlighted the utility of using the CD-40 ligand, which is both a mediator and risk marker for inflammation, as a biomarker for CV risk. Use of a GP IIb/IIIa inhibitor can inhibit the release of CD-40, he said.

Biomarkers can also help assess risk in diabetes. In such patients, the co-occurrence of multiple CAD risk factors increases atheroma, plaque disruption, and thrombogenicity. The co-occurrence of these risk factors can increase the number and severity of CV events and CRP levels. Smoking increases vasoconstriction, elevates CRP levels, and shortens in-vivo platelet survival.

"Acutely, biomarkers can be helpful but are only things that lead us to do interventions," Chesebro said. "Biomarkers, especially CRP, are also useful in the long run to know what risk factors we need to reduce for optimal control."

Disclosures:
• Dr. Chesebro reports no relevant conflicts of interest.