The Korean Journal of Medicine

  • 제82권1호
  • /
  • Pages.45-51
  • /
  • 2012
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

안정형 협심증 환자에서 C-반응성 단백질 농도의 증가

Elevated hs-CRP in Patients with Stable Angina Pectoris

  • 최은진 (전남대학교 의과대학 예방의학교실) ;
  • 신민호 (전남대학교 의과대학 예방의학교실) ;
  • 강원유 (광주보훈병원 심혈관센터) ;
  • 황선호 (광주보훈병원 심혈관센터) ;
  • 김완 (광주보훈병원 심혈관센터) ;
  • 박승욱 (여수전남병원 내과)
  • Choi, Eun-Jin (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Shin, Min-Ho (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Kang, Won-Yu (Cardiovascular Center, Gwangju Veterans Hospital) ;
  • Hwang, Sun-Ho (Cardiovascular Center, Gwangju Veterans Hospital) ;
  • Kim, Wan (Cardiovascular Center, Gwangju Veterans Hospital) ;
  • Bak, Seung-Wook (Department of Internal Medicine, Yeosu Chonnam Hospital)
  • 발행 : 2012.01.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 본 연구는 안정형 협심증 환자 중 관상동맥 조영술을 실시하였던 환자들을 대상으로 고감도 C-반응성 단백질 (high sensitivity C-reactive protein, hs-CRP) 농도와 관상동맥질환의 정도와의 관계를 구명하고자 하였다. 방법: 2006년 6월부터 2010년 8월까지 광주소재 종합병원 심혈관 센터에 내원한 안정형 협심증 환자에서 관상동맥 조영술을 시행한 환자 377명(남자 298명, 여자 79명)을 대상으로 하였다. 자료는 2010년 5월부터 8월까지 수집하였다. 심혈관계 질환의 위험인자들은 의무 기록 조사를 통해 수집하였고, 관상동맥 경화의 정도는 관상동맥 협착이 50% 이상인군과 이하인 군으로 나누어 분석하였다. 결과: 관상동맥 협착이 50% 이상인 군은 전체대상자 377명중 172명으로 45.6%였다. 혈중 hs-CRP가 3.0 mg/L 이상으로 높은 군에서 낮은 군에 비해 관상동맥 협착에 대한 교차비가 2.28 (95% CI = 1.38-3.75)로 높았으며 성별, 나이, 고혈압, 당뇨병, 고밀도 지단백 콜레스테롤을 보정한 이후에 교차비가 1.95 (95% CI = 1.16-3.30)으로 여전히 유의한 관련성을 보였다. 결론: 안정형 협심증 환자에서 높은 혈중 hs-CRP 농도는 50% 이상의 관상동맥 협착과 유의한 관련성을 보였다. 그러나 이러한 관련성을 설명하기 위해서는 좀 더 자세히 평가된 관상동맥 경화의 심각도와 혈중 hs-CRP 농도의 상관관계에 대한 전향적인 연구가 더 이루어져야 할 것이다.

Background/Aims: The association between inflammatory markers and the severity of coronary artery disease (CAD) in patients with stable angina pectoris remains controversial. This study explored the relationships between the serum high-sensitivity CRP (hs-CRP) level and severity of coronary atherosclerosis in patients with stable angina. Methods: The study enrolled 377 stable angina patients (298 males, 79 females) undergoing coronary angiography from June 2006 to August 2010. Based on the coronary angiography results, they were divided into two groups according to the diameter of stenosis (DS): Group I ($DS\;{\geq}\;50%$) and Group II (DS < 50%). Multivariate logistic regression was used to examine the relationship between the hs-CRP level (high hs-CRP ${\geq}\;3.0\;mg/L$ versus low hs-CRP < 3.0 mg/L) and the severity of coronary stenosis. Results: Group I had higher hs-CRP levels than Group II [median hs-CRP (interquartile range); 0.70 (0.3-1.66) versus 1.11 (0.52-3.41) mg/L, p < 0.001]. After adjusting for major cardiovascular risk factors, a high hs-CRP level was significantly related to the severity of coronary atherosclerosis (OR 1.95, 95% CI = 1.16-3.30). Conclusions: Our data show that patients with ${\geq}\;50% $coronary stenosis have higher hs-CRP levels than patients with < 50% coronary stenosis and stable angina. Further study is needed to define the role of hs-CRP in the progression of angina pectoris.

키워드

참고문헌

  1. Alexander RW. Inflammation and coronary artery disease. N Engl J Med 1994;331:468-469. https://doi.org/10.1056/NEJM199408183310709
  2. Libby P, Ridker PM. Novel inflammatory markers of coronary risk: theory versus practice.Circulation 1999;100:1148-1150. https://doi.org/10.1161/01.CIR.100.11.1148
  3. Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993;362:801-809. https://doi.org/10.1038/362801a0
  4. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J 1997;16:735-746. https://doi.org/10.1097/00006454-199708000-00003
  5. Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary eventsin stable and unstable angina: European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet 1997;349:462-466. https://doi.org/10.1016/S0140-6736(96)07591-5
  6. Tracy RP, Lemaitre RN, Psaty BM, et al. Relationship of C-reactive protein to risk of cardiovascular disease in the elderly: results from the Cardiovascular Health Study and the Rural Health Promotion Project. Arterioscler Thromb Vasc Biol 1997;17:1121-1127. https://doi.org/10.1161/01.ATV.17.6.1121
  7. Koenig W, Sund M, Frohlich M, et al. C-Reactiveprotein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation 1999;99:237-242. https://doi.org/10.1161/01.CIR.99.2.237
  8. Rohde LE, Hennekens CH, Ridker PM. Survey of C-reactive protein and cardiovascular risk factors in apparently healthy men. Am J Cardiol 1999;84:1018-1022. https://doi.org/10.1016/S0002-9149(99)00491-9
  9. Ridker PM. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation 2001;103:1813-1818. https://doi.org/10.1161/01.CIR.103.13.1813
  10. Thompson SG, Kienast J, Pyke SD, Haverkate F, van de Loo JC. Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris: European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. N Engl J Med 1995;332:635-641. https://doi.org/10.1056/NEJM199503093321003
  11. Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med 1999;340:115-126. https://doi.org/10.1056/NEJM199901143400207
  12. Rader DJ. Inflammatory markers of coronary risk. N Engl J Med 2000;343:1179-1182. https://doi.org/10.1056/NEJM200010193431609
  13. Hur SH. Lesion characteristics in patients with acute coronary syndrome: a comparison with lesion in patients with stable angina by intravascular ultrasound. Korean Circ J 2004;34:548-557. https://doi.org/10.4070/kcj.2004.34.6.548
  14. Hangartner JR, Charleston AJ, Davies MJ, Thomas AC. Morphological characteristics of clinically significant coronary artery stenosis in stable angina. Br Heart J 1986;56:501-508. https://doi.org/10.1136/hrt.56.6.501
  15. Avanzas P, Arroyo-Espliguero R, Cosín-Sales J, Quiles J, Zouridakis E, Kaski JC. Multiple complex stenoses, high neutrophil count and C-reactive protein levels in patients with chronic stable angina. Atherosclerosis 2004;175:151-157. https://doi.org/10.1016/j.atherosclerosis.2004.03.013
  16. Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107:499-511. https://doi.org/10.1161/01.CIR.0000052939.59093.45
  17. Zebrack JS, Muhlestein JB, Horne BD, Anderson JL; Intermountain Heart Collaboration Study Group. C-reactive protein and angiographic coronary artery disease: independent and additive predictors of risk in subjects with angina. J Am Coll Cardiol 2002;39:632-637. https://doi.org/10.1016/S0735-1097(01)01804-6
  18. Kim KH. The role of chronic infection and inflammation in Korean patients with Coronary Artery Disease. Korean Circ J 2000;30:1107-1116. https://doi.org/10.4070/kcj.2000.30.9.1107
  19. Liuzzo G, Biasucci LM, Gallimore JR, et al. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med 1994;331:417-424. https://doi.org/10.1056/NEJM199408183310701
  20. Anderson JL, Carlquist JF, Muhlestein JB, Horne BD, Elmer SP. Evaluation of C-reactive protein, an inflammatory marker, and infectious serology as risk factors for coronary artery disease and myocardial infarction. J Am Coll Cardiol 1998;32:35-41. https://doi.org/10.1016/S0735-1097(98)00203-4
  21. Uccella R, Donnini P, Franzetti I, Gaiazzi M. Serum lipid pattern as severity indicator of angiographically assessed coronary artery disease. Artery 1993;20:346-360.
  22. Bae JH, Park JS, Hong GR, Shin DG, Kim YJ, Shim BS. Correlation between inflammatory markers and the progression of atherosclerosis in patients with coronary artery disease. Korean J Med 2008;74:51-58.
  23. Koo BK, Choi DH, Kyung HD, et al. Role of inflammation in stable angina patients without hypercholesterolemia. Korean Circ J 2001;31:620-624. https://doi.org/10.4070/kcj.2001.31.7.620
  24. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105:1135-1143. https://doi.org/10.1161/hc0902.104353
  25. Pasceri V, Willerson JT, Yeh ET. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 2000;102:2165-2168. https://doi.org/10.1161/01.CIR.102.18.2165
  26. Cermak J, Key NS, Bach RR, Balla J, Jacob HS, Vercellotti GM. C-reactive protein induces human peripheral blood monocytes to synthesize tissue factor. Blood 1993;82:513-520.
  27. Mendall MA, Strachan DP, Butland BK, et al. C-reactive protein: relation to total mortality, cardiovascular mortality and cardiovascular risk factors in men. Eur Heart J 2000; 21:1584-1590. https://doi.org/10.1053/euhj.1999.1982
  28. Zaroff JG, diTommaso DG, Barron HV. A risk model derived from the National Registry of Myocardial Infarction 2 database for predicting mortality after coronary artery bypass grafting during acute myocardial infarction. Am J Cardiol 2002;90:1-4. https://doi.org/10.1016/S0002-9149(02)02965-X
  29. Ko JS, Joo SY, Jeong MH, et al. Predictive factors for heart failure in patients with unstable angina and acute non-ST elevation myocardial infarction. Korean Circ J 2004;34:459-467. https://doi.org/10.4070/kcj.2004.34.5.459

피인용 문헌

  1. Clinical relevance of high sensitivity C-reactive protein in cardiology vol.52, pp.1, 2016, https://doi.org/10.1016/j.medici.2015.12.001
  2. Trajectory patterns for continuous metabolic syndrome score in childhood and the cardiovascular risk in adolescence vol.11, pp.1, 2012, https://doi.org/10.1038/s41598-021-01566-y