目标:全身低度炎症,通过血浆高敏C反应蛋白(hsCRP)水平测量,是动脉粥样硬化性心血管疾病(ASCVD)的重要危险因素。迄今为止,然而,目前尚不清楚血浆hsCRP是否与不良组织学斑块特征相关.
方法:在颈动脉内膜切除术中获得斑块。评估hsCRP水平≥2mg/L的患者的促炎和不良斑块特征,以及未来的ASCVD事件,并与hsCRP水平低的患者进行比较。除了亚分布风险比之外,还进行了Logistic和线性回归分析,调整心血管危险因素。
结果:共纳入1096例患者,其中494(46.2%)hsCRP水平≥2mg/L。2mg/L的hsCRP水平升高与斑块白介素6的水平独立相关,β系数为109.8(95%置信区间(CI):33.4,186.5;p=0.005)pg/L,白细胞介素8水平,194.8(110.4,378.2;p=0.03)pg/L和脂联素斑块水平,-16.8(-30.1,-3.6;p=0.01)μg/L,与低hsCRP水平患者的斑块相比。组织学分析显示高hsCRP患者血管密度增加,比值比(OR)为1.57(1.20,2.09;p=0.001),较大的脂质核心,1.35(1.02,1.73;p=0.04),巨噬细胞含量增加,1.32(1.02,1.73;p=0.04)。经过3年的随访,hsCRP水平≥2mg/L与冠心病事件风险1.81(1.03,3.16;p=0.04)相关.
结论:在hsCRP水平≥2mg/L的个体中,颈动脉斑块中观察到的明显的炎症和组织学特征强调了血浆hsCRP作为具有高风险斑块患者的有效标识符的实用性。
OBJECTIVE: Systemic low-grade inflammation, measured by plasma high-sensitivity C-reactive protein (hsCRP) levels, is an important risk factor for atherosclerotic cardiovascular disease (ASCVD). To date, however, it is unknown whether plasma hsCRP is associated with adverse histological plaque features.
METHODS: Plaques were derived during carotid endarterectomy. Patients with hsCRP levels ≥2 mg/L were evaluated for pro-inflammatory and adverse plaque characteristics, as well as future ASCVD events, and compared with patients with low hsCRP levels. Logistic and linear regression analyses in addition to subdistribution hazard ratios were conducted, adjusted for cardiovascular risk factors.
RESULTS: A total of 1096 patients were included, of which 494 (46.2 %) had hsCRP levels ≥2 mg/L. Elevated hsCRP levels 2 mg/L were independently associated with levels of plaque interleukin 6, beta coefficient of 109.8 (95 % confidence interval (CI): 33.4, 186.5; p = 0.005) pg/L, interleukin 8 levels, 194.8 (110.4, 378.2; p = 0.03) pg/L and adiponectin plaque levels, -16.8 (-30.1, -3.6; p = 0.01) μg/L, compared with plaques from patients with low hsCRP levels. Histological analysis revealed increased vessel density in high hsCRP patients, odds ratio (OR) of 1.57 (1.20, 2.09; p = 0.001), larger lipid core, 1.35 (1.02, 1.73; p = 0.04), and increased macrophage content, 1.32 (1.02, 1.73; p = 0.04). Over a 3-year follow-up period, hsCRP levels ≥2 mg/L were associated with a hazard ratio of 1.81 (1.03, 3.16; p = 0.04) for coronary artery disease event risk.
CONCLUSIONS: The distinct inflammatory and histological features observed in carotid plaques among individuals with hsCRP levels ≥2 mg/L underscore the utility of plasma hsCRP as a potent identifier for patients harboring high-risk plaques.