血清高敏感C反應蛋白與十年冠心病危險指數的相關性

The Relationship between Serum C-Reactive Protein and the Framingham Coronary Heart Disease Risk Score in Overweight Middle-aged Hospital Employees

預測心臟血管疾病的危險性是預防醫學中重要的常規工作，使用工具以the Framingham Coronary Heart Disease Risk Score (FCRS)為主，而近年來研究文獻發現血清高敏感C反應蛋白(hs-CRP)可以預測心臟血管疾病的危險性，本研究的目的在探討hs-CRP與冠狀動脈心臟病十年預測值的相關。本研究收集某醫院員工體檢體重過重，身體質量指數(BMI)大於24kg/m2者331人參與本研究進入健康促進計劃，以問卷填寫方式，登錄個案基本資料和抽菸飲酒習慣，運動習慣狀況評估，並測量身高、體重、腰臀圍與血壓，血液檢查包含空腹血糖值、hs-CRP、總膽固醇、低密度脂蛋白膽固醇、高密度脂蛋白膽固醇、三酸甘油酯等；計算FCRS，估計十年冠狀動脈心臟病發生率預測值。結果發現無論性別，hs-CRP分成四百分位後，隨著百分位升高，十年冠狀動脈心臟病發生率預測值升高，且與BMI、腰圍及空腹血糖值也有統計上顯著的正相關，而在男性，hs-CRP與血壓值呈正相關，而與高密度脂蛋白膽固醇呈負相關。在邏輯回歸分析時，十年冠狀動脈心臟病發生率預測值高於同年齡性別預測值的狀況，hs-CRP第四百分位組相較於第一百分位組的危險對比值男性為3.6、女性為4.2，經調整腹部肥胖與否後，仍具統計相關。在體重過重之中年人，血清hs-CRP升高會增加十年冠狀動脈心臟病發生率預測值。

The Framingham Coronary Heart Disease Risk Score (FCRS) is recommended for global risk assessment in subjects prone to coronary heart disease (CHD). Recently, high sensitivity C-reactive protein (hs-CRP) has emerged as an independent predictor of CHD, but few data are available evaluating the relationship between hs-CRP and FCRS. We sought to assess the association of hs-CRP levels with FCRS in a cross-sectional study of middle-aged hospital employees. The participants were recruited from the Strong Heart Program of Mackay Memorial Hospital in Taipei from Jul 2004 to Feb 2005 for health promotion activities. This study comprised 331 participants who were overweight with BMI≧24 kg/m2. Medical history, life style, physical examination, body weight and height, waist and hip circumference, blood pressure and laboratory tests including hs-CRP were assessed. We calculated the predicted 10 years CHD incidence by the FCRS. According to the quartiles of hs-CRP, subjects were classified into four groups. Among women and men, calculated 10 years CHD incidence increased from bottom to top groups of hs-CRP. Body mass index, waist circumference, fasting plasma glucose were significantly different among the four groups in both genders. Blood pressure and HDL-cholesterol were significantly different among the four groups in women. The odds ratios of the 4th group (more than 75 percentile) of hs-CRP comparing with the 1st group (less than 25 percentile) for higher predicted risk were 3.6 in men and 4.2 in women. The associations were still significant but slightly weakened after further adjustment for central obesity. Hs-CRP, which is a marker of inflammation, was positively and significantly associated with FCRS and its components in overweight middle aged hospital employees.