The Level Of Serum HsCRP And Endothelium Function In Patients With Cardiovascular Disease

Objective To evaluate the level of serum high-sensitivity C-reactive protein (hsCRP)as an important indicator for early risk stratification in patients with an acute coronarysyndrome (ACS) or other high risk vascular disease. To observe the changes ofendothelium dependent diastolic function in patients with hypertension and otherinfluencing factors (such as obesity and obstructive sleep apnea syndrome).Methods In 216 consecutive patients, the level of serum hsCRP were analyzed.Include 152 male and 64 female, mean age 48.64±18.4 (31-83)yr. According to the clinicalmanifestation, the patients were divided into three groups:①High risk patient group(HRP), 68 patients (49 male and 19 female), mean age 50.2±18.7 yr, include acute coronarysyndrome (ACS) and aortic dissecting aneurysm (ADA);②Low risk patient group (LRP),82 patients (59 male and 23 female), mean age 49.1±18.1 yr, include essential hypertension(BP＜180/110mmHg) and stable angia pectoris;③Control group, 66 patients (44 male and22 female) without vascular disease, mean age 46.6±15.7yr. The 62 consecutive young andmiddle-aged patients with essential hypertension in which some from LRP group, 55 maleand 7 female, mean age 44.97±8.20 (29-65) yr. The group were divided by the bloodpressure level, degree of obesity or obstructive sleep apnea syndrome (OSAS). The highresolution ultrasound was applied to measure brachial artery flow-mediated endothelium-dependent dilation and glyceryhrinitrate (GNT) -mediated endothelium-independent dilation.Results①Compared with the control group (0.37±0.25mg/L), the serum hsCRPlevels in both of LRP group (1.28±0.79 mg/L, p＜0.05) and HRP group (5.82±3.94 mg/L,p＜0.01) were significantly increased; the level of serum hsCRP in HRP group was alsosignificantly higher than that in LRP group (p＜0.01). The cutoff values were 3.0mg/L forserum hsCRP, its sensitivity and specificity for patients with high risk cardiovasculardisease (especially ACS or ADA) were 73.53% and 75.36% respectively; the false positiverate is 11.49%, and the false negative rate is 26.47%. The levels of serum CK-MB (cutoff value 25IU/L) and cTnl (cutoff value 0.1μg/L) in control and LRP groups are normal. Theserum levels of CK-MB and cTnI are not related to the hsCRP level.②The endotheliumdependent diastolic function (EDD) in severe hypertension group (BP≥180/110mmHg) wasdecreased significantly versus the mild hypertension group (p＜0.01). Central-type obesityand OSAS could also affect EDD obviously.Conclusion①The level of serum hsCRP in HRP group was obviously higher thanother groups. The 3.0 mg/L serum hsCRP as cutoff value is useful for identifying thepatients with ACS or ADA. But the final diagnosis should be made by combination withother important clinical data.②The decrease of endothelium dependent diastolic function(EDD) in hypertension may be an early appearance of the damage in arterial wall.Central-type obesity and OSAS may also influence EDD as important factors.