C-reactive protein. Downloaded from ijdld.tums.ac.ir at 4:22 IRST on Tuesday December 18th C-reactive protein (CRP) : CRP.

Transcript

1 - ( ). C-reactive protein 5* C-reactive protein () :.. ) polypill 2 Polypill : -79 ( (%64) FBS <126 mg/dl WBC <12000 per µl <1/3 mg/dl high sensitivity (hs) (P=0/001) [0/9 (0/4 2) mg/l] [1/3 (0/7 2/6) mg/l] (IQR) : (P=0/009) (P=0/002) (P=0/001) (P=0/006) (P=0/001) (P=0/042) (P=0/007) HDL. log. :. : : : : : : * pourshams@ams.ac.ir 88/7/27 : 88/7/12 : 88/3/25:

2 ... C-reactive protein : polypill. 2/ / Polypill ( ) 872 (OTC) mg/dl WBC per µl Cr 1/3 mg/dl FBS (kg) (BMI). high. (m) sensitivity (hs) ( ) mg/l. intra- and interassay coefficients of variation. 1/7 2/6 hs LDL HDL 1- Over-The-Counter 2- Body Mass Index C-. reactive protein ()..[1]. IL6.[2 3] ATPIII 3 HDL.[4].[5].. Polypill. Polypill 2 polypill ).[6].(

3 91 ( ). 252 (%64) (%36) SD ±.. 59/5 ± 7/1 log (1 ) (IQR). mg/l 1/0 (0/5 2/3) mg/l 1/3 (0/7 2/6) mg/l %3 0/9 (0/4 2).( P = 0/001).(2 ) 10 mg/dl 3. log 4. log log (P = 0/04) 6 5.(P = 0/77). log stepwise. HDL.(7 ) ( ) intra- and. interassay coefficients of variation 1/6 1/5 1/1 1/6 1/29 0/6 LDL 1/8 0/8 HDL 2/21 1/19 1/74 HbA 1 C. 2/73. BMI (Interquartile range, IQR) SD ± LDL.. BMI LDL (chi-square) Mann-Withney U. t-test log. log Pearson stepwise. z- SPSS.. 16 test (SPSS Inc., Chicago, IL). P <0/05

4 ... C-reactive protein : 92 n = n = /6 ± 5/9 58/9 ± 7/ 6 *() ± SD 27 /0(23/7 30/2) 24/9(22/3 27/7) *(Kg/m 2 )(IQR) BMI 93/1±13/2 91/4 ± 11/ 7 (cm)sd ± 1/0 ± 0/9 ± 0/ 1 * 96 ± ± 10 (mg/dl)sd ± FBS 127 (94 181) 119 (87 168) *( mg/dl)(iqr) TG 177 (99 141) 107 (88 126) *( mg/dl)(iqr) LDL 49 ± ± 10 *(mg/dl)sd ± HDL 212 ± ± 45 *(mg/dl)sd ± 8/5 ± 1/0 5/5 ± 0/ 9 *(%)SD ± HbA 1 C 4/8 ± 1/1 5/5 ± 1/ 2 *(mg/dl)sd ± 129 ± ± 18 (mmhg)sd ± 70 ± ± 11 *(mmhg)sd ± 1 /3(0/7 2/6) 0/9(0/4 2/0) *( mg/l)(iqr) % 2/4 % 17 (%) * Mann Whitney U T :IQR :SD.(P < 0/05) P * Frequency (n) (mg/dl) ( n= 691) -1

5 93 ( ). 97 9/ /2 10/4 10/4 11/7 6/4 9/3 90 4/3 5/3 4/7 4/6 4/7 5/9 3/0 4/9 n (%) 352(50/9) 219(31/7) 120(17/4) 691(100) /8 2/3 2/2 2/0 2/4 2/9 2/2 2/6 50 0/9 0/9 1/0 0/9 1/1 1/5 1/1 1/3 25 0/4 0/6 0/4 0/4 0/6 0/8 0/8 0/7 10 0/2 0/3 0/3 0/3 0/2 0/3 0/6 0/3 3 0/ () n (%) 105(42/4) 104(41/6) 40(16) 249(100) n (%) 247(55/9) 119(26) 80(18/1) 442(100) * mg/l1 < * mg/l3 1 mg/l 3 >. P * 4 r (p) 0/09(0/018) 6(0/0001) 7(0/0001) 6(0001) 3(0/001) 1(0/002) -3(0/001) 5(0/001) 2(0/004) 4(0/0001) 7(0/0001) 5(0/0001) 0/06() r (p) 0/06(0/2) 4(0/02) 2(0/06) 1(0/07) 5(0/01) 0(0/09) -4(0/01) 8(0/003) 0/09(9) 0/26(0/0001) 0/25(0/0001) 0/09() 0/02(0/66) r (p) 0/08(0/07) 5(0/001) 9(0/0001) 9(0/0001) 0/091(0/05) 1(0/01) -7(0/0001) 1(0/02) 1(0/02) 0/08(0/08) 9(0/0001) 9(0/0001) 0(0/04) BMI TG HDL LDL HbA 1 C FBS

6 ... C-reactive protein : 94 (mg/l) (95%CI) (95%CI) 1/3 ( 1/0-1/7) 1/1 (0/9 1/3) 1/5 (1/2 1/8) 1/1(0/9 1/3) 4/4 (1/1 1/6) 1/1 (0/9 1/3) 1/7 (1/4 2/1) 1/0 (0/9 1/2) 1/4 (1/2 1/7) 1/1 (0/9 1/3) 5 (cm 88< ) *( 150 mg/dl) (< 50 mg/dl) HDL *(FBS 100 mg/dl) *( 130/85 mmhg ).(P < 0/05) P * (mg/l) (95%CI) - 6 (95%CI) 1/4 (1/1 1/7) 0/9 (0/8 1/0) 1/1 (0/9 1/3) 0/9 (0/8 1/0) 1/2 (1/0 1/5) 0/8 (0/7 0/9) 1/3 (1/1 1/5) 0/9 (0/8 1/0) 1/2 (1/0 1/4) 0/8 (0/7 1/0) *(cm 102< ) ( 150 mg/dl) *(< 40 mg/dl) HDL *(FBS 100 mg/dl) *( 130/85 mmhg ).(P < 0/05) P *

7 95 ( ). stepwise 7 β / WBC..[14 13] LDL [15] HDL [16].[14]. 25.[9 8] BMI * * * *HDL * *FBS *.(P < 0/05) P *...[7-10] [11 8] LDL BMI LDL.. ICAM-1 Selectin CD40L CD40 VCAM-1.[12] 10 %3.[9 7] %5

8 ... C-reactive protein : [17]. HDL HDL LDL.[18] LDL. 1..[19]..[12]. 2 PAI-1 IL6.[20] HDL...[21] 1- Foam cell 2- Plasminogen activator inhibitor

9 97 ( ). 1. Bassak SS, Rifai N, Ridker PM. High sensivity C-reative protein: clinical importance. Curr probl cardiol 2004; 29: Calabro P, Willerson JT, Yeh ET. Inflammetory cytokines stimulated C-reactive protein production by human coronary artery smooth muscle cells. Circulation 2003; 108: Yasojima K, Schwab C, McGeer EG, McGeer PL. Generation of C-reactive protein and complement components in atherosclerotic plaques. Am J Pathol 2001; 158: Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285: Festa A, D'Agostino R, Howard G, Mykkanen L, Tracy RP, Haffiner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000; 102: Phase II study of heart polypill safety and efficiency in primary prevention of cardiovascular disease. National Institute of Health. /NC T ? Order=59 (update: 29 May, 2009). 7. Rifai N, Ridker PM. Population distributions of C-reactive protein in apparently healthy men and women in the united state: implication for clinical interpretation. Clin Chem 2003; 49: Hutchinson WL, Koenig W, Fröhlich M, Sund M, Lowe GD, Pepys MB. Immunioradiometric assay of ciurculating C-reactive protein: age related values in the adult general population. Clinical Chemistry 2000; 46: Imhof A, Fröhlich M, Loewel H, Helbecque N, Woodward M, Amouyel P, et al. Distributions of C-reactive protein measured by high-sensitivity assays in apparently healthy men and women from different populations in Europe. Clinical Chemistry 2003; 149: Yamada S, Gotoh T, Nakashima Y, Kayaba K, Ishikawa S, Nago N, et al. Distribution of serum C-reactive protein and its association with atherosclerotic risk factors in a Japanese population: Jichi Medical School Cohort Study. Am J Epidemiol 2001; 153: Khera A, McGuire DK, Murphy SA, Stanek HG, Das SR, Vongpatanasin W, et al. Race and gender differences in C-reactive protein levels. J Am Coll Cardiol 2005; 46: Young JL, libby P, Schonbeck U. Cytokines in the pathogenesis of atherosclerosis. Thromb Haemost 2002; 88: Araujo F, Pereira AC, Latorre Mdo R, Krieger JE, Mansur AJ. High sensitivity C-reactive protein concentration in a healthy Brazilian population. Int J Cardiol 2004; 97: Bermudez EA, Rifai N, Buring JE, Manson JE, Ridker PM. Relation between markers of systemic vascular inflammation and smoking in women. Am J Cardiol 2002; 89: Craig WY, Palomaki GE, Haddow JE. Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of published data. BMJ 1989; 298: Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD, Reaven GM. Insulin resistance and cigarette smoking. Lancet 1992; 339: Yudkin JS, Kumari M, Humphries SE, Mohamed-Ali V. Inflammation, obesity, stress and coronary heart disease; is interlukin-6 the link? Atherosclerosis 2000; 148: Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, et al. HDL cholesterol, very low levels of LDL cholesterol and cardiovascular events. N Engl J Med 2007; 357: Tabas I. Consequences of cellular cholesterol accumulation: basic concepts and physiological implications. J Clin Invest 2002; 110: Ridker PM, Buring JE, Cook NR, Rifai N. C- reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of initially healthy American women. Circulation 2003; 107: Johnson RJ, Segal MS, Srinivas T, Ejaz A, Mu W, Roncal C, et al. Essential hypertension, progressive renal disease and uric acid: a pathogenetic link? J Am Soc Nephrol 2005; 16: 1909.

10