糖尿病与发炎指标CRP.VIP免费

糖尿病與發炎指標CRP吳達仁醫師成大醫學院附設醫院內科部內分泌新陳代謝科CRP:FromAcutePhaseProteintoCRP:FromAcutePhaseProteintoCardiovasculardiseaseCardiovasculardisease•CRPisasymmetricalringmoleculethatconsistsof5noncovalentbutassociateprotomers.Eachprotomerhas2calciumionsresponsibleforthespecificbindingofphosphochlorine.Phosphochlorineisacommonconstituentofmanybacterialandfungalpolysaccharidesandmostbiologiccellmembranes,suchasthephosphochlorineresiduesofC(orcapsular)-polysaccharideofStreptococcuspneumoniae.Theproteinwasnamed“C-reactive”becauseofthisreaction.•Astablepentamericprotein-compoundwithahalf-lifeof19hours,withoutdiurnalvariation,•CRPisapathogenicmarkerandanonspecificmarkerofinflammation.CRPissynthesizedinresponsetotheacutephaseofabacterialorfungalinfection.MolecularStructureandMorphologyofHumanCRPMolecularStructureandMorphologyofHumanCRP(a)Negativelystainedelectronmicrographshowingthetypicalpentamericdisc-likestructureface-onandside-on(arrows).(b)Ribbondiagramofthecrystalstructure,showingthelectinfoldandthetwocalciumatoms(spheres)intheligand-bindingsiteofeachprotomer.(c)Space-fillingmodeloftheCRPmolecule,showingasinglephosphocholinemoleculelocatedintheligand-bindingsiteofeachprotomer).PepysMB,etal.ClinInvest2003;111:1805-1812.AssaysofCRPandReferenceRangesAssaysofCRPandReferenceRangesDuringtheacutephaseofinfection,serumCRPlevelsweremeasuredbyratenephelometry(“serumCRPassay”).Theseassayshavealowerlimitofdetectionofonly6to10mg/l.Amoresensitivelatexparticle-enhancedimmunoturbidimetricassay(“highsensitivity[hs]-CRPassay”)hasbeendevelopedthathasalowerlimitofdetection(orsensitivity)ofabout0.15mg/l.Itisusedtoassessforcardiovascularrisk.Theriskfactorsbyhs-CRPlevels(CDC,AHA):•CRP1mg/lislowCVDrisk•CRP1to3mg/lismoderateCVDrisk•CRP3to10mg/lishighCVDrisk•CRPlevels10mg/lgenerallyindicatesbacterialinfectionDemographicandDescriptiveCharacteristicsoftheDemographicandDescriptiveCharacteristicsoftheUSPopulationWithoutaPreviousDiagnosisofUSPopulationWithoutaPreviousDiagnosisofHypertensionFromNHANESIIIHypertensionFromNHANESIIIMatthiasB.etal.DiabetesCare2004;27:1680-1687.140140180180mg/dL051015PravastatinPlaceboWOSCOPS:OverlapAnalysisWOSCOPS:OverlapAnalysisFrequencyper100Frequencyper100OntreatmentLDLOntreatmentLDLnEvents1120108107167PlaceboPravastatinRRonPravastatin=0.65Logrankp=0.002Adjustforon-treatmentLDL,HDL,VLDL,TG&baselinecovariates.RRonPravastatin=0.64,p=0.0147777155155116116194194232232mg/dLmg/dLWOSCOPSGroup.Circulation.1998;97:1440-45TheEffectsofAtorvastatinversusSimvastatinonAtherosclerosisProgressionStudy(ASAP)AtorvastatinreducedCRPlevelstoagreaterextentthansimvastatinvanWissenS,etal.Atherosclerosis.2002;165:361-366.*P<0.001fordifferencebetweengroups;**P=0.02fordifferencebetweengroups***-50-45-40-35-30-25-20-15-10-501Year2YearsAtorvastatinSimvastatinPercentchangeinhs-CRP-44.9-14.0-40.1-19.7InfluenceofBaselineBMIonAbilityofAtorvastatintoModifyCVRiskFactors(REVERSALStudy),-40,-55,-33,-36,-49,-40-60-50-40-30-20-100=MedianP<0.01P<0.01P<0.05%NichollsSJ,etal.AmJCardiol2006;97:1553-7.TotalChLDL-CTotalChLDL-CCRPCRPEffectsofSwitchingPravastatintoCerivastatinonEffectsofSwitchingPravastatintoCerivastatinonC-ReactiveProtein,Butyrylcholinesterase,andLipC-ReactiveProtein,Butyrylcholinesterase,andLipidsids•Patientswereeligibleforinclusioniftheyhadanactivepr...