动脉炎症与CRP医学课件

1、Inflammation and CRPPrimary Pro-Inflammatory Cytokines (eg, IL-1, TNF-a a)IL-6“Messenger” CytokineICAM-1Selectins, HSPs, etc.LiverEndotheliumand other cellsCRPSAAAdapted from Libby P et al.Circulation. 1999;100:11481150.Inflammatory Pathways in AtherogenesisCirculationPro-inflammatory Risk FactorsVS

2、MCmigrationFoam-cellformationAdherence andaggregation of plateletsAdherence andentry of leukocytesT-cellactivationAtherosclerosis: An Inflammatory DisorderVSMC, vascular smooth muscle cell migration.Inflammation, Plaque Stability, and the Risk of Cardiovascular Events Evidence suggests that in ACS e

3、levated inflammatory markersin particular, CRPpredict the future risk of cardiovascular events Factors such as laminar arterial shear stress, oxidized LDL, free radicals, and infectious organisms can trigger the release of pro-inflammatory cytokines (eg, IL-1, TNF-a, IL-6) Inflammatory cytokines inf

4、luence the stability and degradation of the fibrous cap, leading to plaque rupture and subsequent thrombosisACS, acute coronary syndrome; CRP, C-reactive protein; LDL, low-density lipoprotein; IL, interleukin; TNF, tumor necrosis factor.Libby P, et al. Circulation. 2002;105:1135-1143. hs-CRP and Ris

5、k of Future MI in Apparently Healthy Men P.001P.001P=.03Quartile of hs-CRP P Trend .001Relative Risk of MI01231234hs-CRP, high-sensitivity C-reactive protein; MI, myocardial infarction.Adapted from Ridker PM, et al. N Engl J Med. 1997;336:973-979.Relative Risk of Cardiovascular Events According to S

6、everal Biochemical Markers01.02.04.06.0Lipoprotein(a)LDLCHomocysteineTCApolipoprotein BTC:HDLChs-CRPhs-CRP + TC:HDLCRelative Risk of Future CV EventsCV, cardiovascular; TC, total cholesterol; LDLC, low-density lipoprotein cholesterol; HDL-C, high-density lipo-protein cholesterol; CRP, C-reative prot

7、ein; hs-CRP, high-sensitivity C-reactive protein; TC, total cholesterol.Adapted from Rifai N, et al. Clin Chem. 2001;47:28-30.Novel Risk Factors as Predictors of PADVCAM, vascular cell adhesion molecule; LDLC, low-density lipoprotein cholesterol; ICAM, intercellular adhesion molecule; hs-CRP, high-s

8、ensitivity C-reactive molecule; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol.* Adjusted for age, smoking, diabetes, hypertension, family history, exercise level, and body mass index.Ridker PM, et al. JAMA. 2001;285:2481-2485.01.02.04.06.0Lipoprotein(a)HomocysteineVCAM-1Fibrinog

9、enLDLCICAM-1hs-CRPTC:HDLCCRP + TC: HDLCRelative Risk of Incident PAD*CRP, the Metabolic Syndrome, and Future CV Events (N=14,719)CRP, C-reactive protein; CV, cardiovascular.Ridker PM, et al. Circulation. 2003;107:391-397. (with permission)Follow-up (years)CV-Eventfree Survival Probability0.960.970.9

10、80.991.00ATP III Metabolic Syndrome NoATP III Metabolic Syndrome YesCRP 3.00684202468Risk Factors for Future Cardiovascular Events: Womens Health StudyIL, interleukin; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; sICAM, serum intercellular adhesion molecule; SAA, serum amyloid

11、A; ApoB, Apolipoprotein B; HDL-C, high-density lipo-protein cholesterol; hs-CRP, high-sensitivity C-reactive protein.Ridker PM, et al. N Engl J Med. 2000;342:836-843.Relative Risk of Future Cardiovascular Events01.02.04.06.0Lipoprotein(a)HomocysteineIL-6TCLDL-CsICAM-1SAAApo BTC: HDL-Chs-CRPhs-CRP +

12、TC: HDL-CMarkers of Inflammation in the Prediction of Cardiovascular Disease in Womenhs-CRP, high-sensitivity C-reactive protein; SAA, serum amyloid A; sICAM, serum intracellular adhesion molecule; IL, interleukin.Ridker PM, et al. N Engl J Med. 2000;342:836-843. (with permission)0.01.02.03.04.05.06

13、.0HighMediumLowLowMediumHighTotal Cholesterolhs-CRPRelative RiskTotal Cholesterol0.01.02.03.04.05.06.0HighMediumLowLowMediumHighRelative RiskTotal CholesterolsICAM-10.01.02.03.04.05.06.0HighMediumLowLowMediumHigh0.01.02.03.04.05.06.0HighMediumLowLowMediumHighRelative RiskTotal CholesterolSAARelative

14、 RiskIL-69、 人的价值，在招收诱惑的一瞬间被决定。2022-1-82022-1-8Saturday, January 08, 202210、低头要有勇气，抬头要有低气。2022-1-82022-1-82022-1-81/8/2022 7:31:19 AM11、人总是珍惜为得到。2022-1-82022-1-82022-1-8Jan-228-Jan-2212、人乱于心，不宽余请。2022-1-82022-1-82022-1-8Saturday, January 08, 202213、生气是拿别人做错的事来惩罚自己。2022-1-82022-1-82022-1-82022-1-81/8/

15、202214、抱最大的希望，作最大的努力。2022年1月8日星期六2022-1-82022-1-82022-1-815、一个人炫耀什么，说明他内心缺少什么。2022年1月2022-1-82022-1-82022-1-81/8/202216、业余生活要有意义，不要越轨。2022-1-82022-1-8January 8, 202217、一个人即使已登上顶峰，也仍要自强不息。2022-1-82022-1-82022-1-82022-1-8hs-CRP, Aspirin, and Risks of Future Myocardial Infarctionhs-CRP, high-sensitivit

16、y C-reactive protein.Ridker PM, et al. N Engl J Med. 1997;336:973-979. (with permission)123401234Placebo AspirinRelative RiskMyocardial InfarctionQuartile of C-Reactive ProteinRelative RiskInflammation AbsentInflammation PresentInflammation, Statin Therapy, and Relative Risk of Recurrent Coronary Ev

17、ents0123PravastatinPlaceboPravastatinPlaceboRidker PM, et al. Circulation. 1998;98:839-844. (with permission)Long-term Effect of Pravastatin on hs-CRP: Placebo and Pravastatin Groupshs-CRP, high-sensitivity C-reactive protein.Adapted from Ridker PM, et al. Circulation. 1999;100:230-235.PravastatinPl

18、aceboMedian hs-CRP Concentration (mg/dL)-21.6%(P=.007)0.180.190.200.210.220.230.240.25Baseline5 YearsStudy GroupStatin (mg/dl)Placebo (mg/dl) NNTLow LDL-C/low CRP0.0250.022-Low LDL-C/high CRP0.0290.05148High LDL-C/low CRP0.0200.05033High LDL-C/high CRP0.0380.05558Median LDL-C = 149 mg/dLMedian CRP=

19、0.16 mg/dLCRP as a Method to Target Statin Therapy in Primary Prevention: AFCAPS/TexCAPSCRP, C-reactive protein; AFCAPS/Tex Caps, AirForce Texas Coronary Athersclerosis Prevention Study; NNT, number needed to treat; LDL-C, low-density lipoprotein cholesterol.Adapted from Ridker PM, et al. N Engl J M

20、ed. 2001;344:1959-1965.CRP, Metabolic Syndrome, and Future CV Events (N=14,719)CRP, C-reactive protein; CV, cardiovascular.Ridker PM, et al. Circulation. 2003;107:391-397. (with permission)Follow-up (years)CV-Eventfree Survival Probability0.960.970.980.991.00ATP III Metabolic Syndrome NoATP III Meta

21、bolic Syndrome YesCRP 3.00246801234502468C-reactive Protein (mg/L)Number of Components of the Metabolic SyndromeRidker PM, et al. Circulation. 2003;107:391-397. (with permission)Metabolic Syndrome and CRP LevelsCRP (mg/L)Risk3 HighRidker PM. Circulation. 2003;107:363-369. (with permission)CRP Levels

22、 and Event-Free Survival02468Follow-up (years)0.950.960.970.980.991.001 mg/L1 to 3 mg/L160130 - 160130 3.0Multivariate Relative RiskLDL CholesterolCRP mg/LClinical Application of hs-CRP for Cardiovascular Risk Prediction 1 mg/L3 mg/L10 mg/LLowRiskModerate RiskHighRiskAcute Phase ResponseIgnore Value

23、, Repeat Test in 3 weeks100 mg/LAdapted from Ridker PM. Circulation. 2003;107:363-369.Clopidogrel Reduces ADP-Induced Expression of Platelet-Derived CD40L* ASA 100 M in vitro. Clopidogrel 75 mg/d for 7 d.CD40L, CD40 ligand; ASA, acetylsalicylic acid.Hermann A, et al. Platelets. 2001;12:74-82. (with

24、permission)00.10.20.30.40.5Control ADP 30 MCD40L Expression (Mn X)ControlASA*ClopidogrelASA* + clopidogrelP.05 vs ADP-stimulated controlsInflammation in Unstable Angina-15-10-5051015UA/LAD(n=24)UA/RCA (n=9)Stable Angina (n=13)Variant Angina (n=13)Controls (n=6)Myeloperoxidase IndexFemoral VeinAortaG

25、reat Cardiac VeinBuffon A, et al. N Engl J Med. 2002;347:5-12. (with permission)CRP, C-reactive protein.Chew DP, et al. Circulation. 2001;104:974-975.6.0 %9.6 %12.3 %2.3 %0.4 %0 %0 %15.3 %0 %5 %10 %15 %20 %1.1mg/dLDeathDeath/MI(n=216)(n=218)(n=227)(n=216)* 2 for trend=0.001* 2 for trend=0.003*CRP Quartiles (mg/dl)CRP and Outcome by Quartile inStented Patients9、 人的价值，在招收诱惑的一瞬间被决定。22.1.822.1.8Saturda