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hs-CRP level represents the disease burden and the age but not vulnerability of coronary atherosclerosis

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dc.contributor.author박, 세준-
dc.date.accessioned2013-12-19-
dc.date.available2013-12-19-
dc.date.issued2013-
dc.identifier.urihttp://repository.ajou.ac.kr/handle/201003/8652-
dc.description.abstract목적:hs-CRP (high sensitive C-reactive protein)는 동맥경화증의 염증 표지자로 알려져 있으며, 심혈관 질환의 예후를 예측하는 인자로도 인식되고 있다.몇몇 연구들을 통해 hs-CRP 수치가 죽상반의 취약성과 연관이 있다고 밝히고 있지만, 이들 대부분은 관상동맥 전체가 아닌 국소적인 죽상반에 대한 연구로써 그 한계점을 가지고 있다.

방법:63명의 환자들의 총 189개의 혈관에 대해서 가장조직-혈관내초음파를 시행하여 분석한 죽상반결과를 혈중 hs-CRP 수치와 비교 분석하였다. 가상조직 혈관내초음파는죽상반의 성분을 fibrous, fibrofatty, necrotic core, dense calicum으로4개의 색을 통해 구별하였고, 죽상반의 양적 분석 결과 및 thin cap fibroatheroma(VH-TCFA)유무도 hs-CRP와 수치와 비교하였다. 혈중 hs-CRP는 혈관내 초음파 및 관상동맥 조영술 전에 채혈하였다..

결과: 급성 관동맥 증후군은 전체 환자 중49명(77.8%)이였다.혈중 hs-CRP 수치는 평균 0.24±0.52 mg/dl (0~3.27mg/dl)이였고, 혈관의 길이는 각각 좌전하행지56.1±17.4 mm,좌회선지 51.9±19.0 mm, 우관상동맥74.2±18.8 mm였다. VH-TCFAs는 평균적으로 좌전하행지 1.0±0.8개, 좌회선지 0.6 ±0.7개, 우관상동맥0.8±1.0개가 존재하였다.혈중 hs-CRP 수치는 평균 죽상반 양, 총 죽상반 양, fibrofatty 및 dense calcium의 양적 지수와 양의 상관관계를 보였다. 그러나 necrotic core의 각종 양적 수치들과 VH-TCFA와는 유의한 상관관계를 보이지 못했다. 다변량 분석결과 dense calcium의 양적 지수가 hs-CPR를 가장 잘 예측하는 인자로 분석되었다. (β=3.646, CI=2.036 to 5.255, p<0.001)

결론:이상의 결과를 통해 혈중 hs-CRP 수치는 죽상반의 취약성보다는 동맥경화증의 양적 및 질적 정도와 연관성이 있음을 알 수 있었다. 이를 통해 혈중 hs-CRP 수치를 통해 심혈관 질환의 예후를 예상할 수 있을 것으로 생각된다.
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dc.description.abstractBackground: hs-CRP (high sensitive C-reactive protein) has been known as a systemic inflammatory marker of atherosclerosis and considered as one of the predictors of future cardiac events. Some reports presented hs-CRP level was associated with plaque vulnerability but most studies were performed by assessing focal target plaque but not whole plaques from a coronary tree.

Methods: To evaluate of the relationship of plasma hs-CRP level and volumetric plaque composition of the coronary arterial tree, we performed ‘whole vessel” virtual histology-intravascular ultrasound (VH-IVUS) in 189 vessels of 63 patients. The components of atherosclerosis were classified as fibrous (FI), fibrous-fatty (FF), necrotic core (NC) and dense calcium (DC). Quantitative assessment of these plaque components and the presence of VH-IVUS–derived thin-cap fibroatheroma (VH-TCFA) in the coronary arterial trees were compared to hs-CRP levels in individuals. hs-CRP levels were measured before coronary angiogram and IVUS study.

Results: Forty-nine patients (77.8%) were diagnosed with acute coronary syndrome in this population. The mean values of hs-CRP were 0.24±0.52 mg/dl (0~3.27mg/dl). The analyzed vessel length was 56.1±17.4 mm for the left anterior descending coronary artery, 51.9±19.0 mm for the left circumflex coronary artery, and 74.2±18.8 mm for the right coronary artery. The number of VH-TCFAs was 1.0±0.8 for the left anterior descending, 0.6±0.7 for the left circumflex, and 0.8±1.0 for the right coronary arteries.The hs-CRP levels were positively correlated to mean plaque burden, total plaque volume index, volume index of FF and DC. But parameters of NC and the number of VH-TCFA were not related with hs-CRP level. In multivariate analysis, the volume index of DC was most reliable factor to hs-CRP (β=3.646, CI=2.036 to 5.255, p<0.001) Conclusions: This three-vessel VH-IVUS presented that hs-CRP were related to the total atherosclerotic burden and the maturing (coronary calcium) but not vulnerable features (NC or VH-TCFA) of plaques in coronary arterial tree. Increased hs-CRP level as a biomarker to predict cardiovascular events might imply atherosclerosis severity of whole coronary tree but not current plaque vulnerability.
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dc.language.isoen-
dc.titlehs-CRP level represents the disease burden and the age but not vulnerability of coronary atherosclerosis-
dc.title.alternative혈중 hs-CRP와 관상동맥경화증 중등도 및 죽상반 취약성과의 연관 관계에 대한 연구-
dc.typeThesis-
dc.identifier.urlhttp://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000014769-
dc.subject.keywordhigh sensitive C-reactive protein-
dc.subject.keywordhs-CRP-
dc.subject.keywordcoronary atherosclerosis-
dc.subject.keywordvirtual histology-
dc.subject.keywordintravascular ultrasound-
dc.subject.keywordvulnerable plaque-
dc.subject.keywordvulnerability-
dc.subject.keyword관상동맥경화증-
dc.subject.keyword혈관내 초음파-
dc.subject.keyword죽상반 취약성-
dc.description.tableOfContentsABSTRACT i

TABLE OF CONTENTS iii

LIST OF FIGURES iv

LIST OF TABLES vi

INTRODUCTION 1

II. MATERIAL AND METHODS 2

A. PATIENTS 2

B. LABORATORY ASSESSMENT 2

C. IVUS IMAGING AND ANALYSIS 2

D. STATISTICAL ANALYSIS 3

III. RESULTS 4

A. BASELINE CLINCAL AND VH-IVUS DATA 4

B. CORRELATION BETWEENHS-CRP AND PLAQUE COMPONENTS 9

IV. DISCUSSION 15

V. CONCLUSION 18

REFERENCES 19

국문요약 23
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dc.description.degreeMaster-
dc.contributor.affiliatedAuthor박, 세준-
dc.date.awarded2013-
dc.type.localTheses-
dc.citation.date2013-
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Theses > School of Medicine / Graduate School of Medicine > Master
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