NGHIÊN cứu GIÁ TRỊ của HS CRP và IL 6 TRONG LƯỢNG gía NGUY cơ TIM MẠCH TỔNG QUÁT ở BỆNH NHÂN TĂNG HUYẾT áp NGUYÊN PHÁT

NGHIÊN CU GIÁ TR CA HS-CRP VÀ IL-6
CH TNG QUÁT
 BT ÁP NGUYÊN PHÁT

Lê Th Thu Trang
1
, Hu
2
,
nh
3

1
1

2
c 
3




 
hs-CRP và IL- 
-CRP và IL-6 trong

 Nghiên cu 140 BN THA nguyên phát u tr thuc ch
hoc b u tr  03 tháng. Ch ng yu t 
i lon Lipide máu theo hi Tim mch Ving, tha cân, béo
phì theo tiêu chun ca WHO dành cho i lon Glucose máu

n Hng M ng hs-
c phn ng kháng nguyên kháng th trên ht latex, thc hin trên máy OLYMPUS OSR 6199.
ng IL-6 theo nguyên lý phn ng min dch tun t quang hóa gc,
thc hin trên máy IMMULITE ca hãng SIEMENS ti BVTW Hu.
 1) Trung bình hs- 
-
- - 
-
2
= 24,64, p < 0,0001; và
-6 
2

-  1,41
-6
(pg/ml) - - 
-CRP = 2,9 mg/l và IL-6 =
-CRP và IL- quát
- 26,5) và 9,6 (2,9 - 32), p = 0,0001 và p < 0,0001; OR (95%
- -CRP và 9,6 (2,6 -
--CRP phâ
- 
-CRP là 0,36 (0,21 - 0,5).
 -
CRP và IL-6; 2) --
-
2,9 mg/l).

SUMMARY

VALUES OF HS-CRP AND IL-6 IN PREDICTING GLOBAL CARDIOVASCULAR
RISK IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objectives: (1) To demonstrate the relation of elevated levels of hs-CRP and IL-6 to the
severity of HTN and stratification of global cardiovascular risk in patients with essential HTN,
and (2) To study values of hs-CRP and IL-6 in predicting global cardiovascular risk in patients
with essential HTN.
Methods: 140 patients with essential HTN never-     
months were enrolled. Diagnosis and classification of HTN, stratification of risk and
determination of dyslipidemia were made according to Vietnam heart association guidelines.
Determination of over-weight and obesity were based on WPRO criteria. Estimation of fast
glucose intolerance according to criteria of ADA. Hs-CRP was quantitatively tested based on
antigen - antibody reaction assay, measurement of turbidity on Latex particles, performed with
OLUMPUS OSR 6199. IL-6 was quantitatively tested based on solid-phase, enzyme-labeled,
chemoluminescent sequential immunometric assay, performed with IMMULITE of SIEMENS.
Results: It was demonstrated that there were relations between the severity of HTN and
elevated levels hs-CRP (cut-off point 2.01 mg/l, p < 0.0001) and IL-6 (cut-off point 4.6 pg/ml, p
= 0.0204). Similarly, there were also relations between elevated levels of hs-CRP and IL-6 (cut-
off points 2.9 mg/l and 3.5 pg/ml respec 
 -CRP and IL-6 in high and very high stratum to low and moderate stratum being
respectively 9.6 (3.5-26.5) and 9.6 (2.9-32) (p = 0.0001 & p < 0.0001); and after corrected with
other CV risks u 31)
(p < 0.0001) for hs-CRP and 9.6 (2.6  35) (p = 0.0007) for IL-6. Analysing the ROC curve of
hs-CRP differentiating patients with high and very high CV risk presented with AUC (95% CI) =
0.746 (0.666-0.816), p < 0.0001; with recommended cut-off point being 2.9 mg/l, the agreement
coefficient () 0.36 (95% CI = 0.21-0.5).
Conclusions: There existed relations between elevated levels of hs-CRP and IL-6 and the
severity of HTN, and as well strata of global CV risk. With cut-off point of 2.9 mg/l, hs-CRP
was proved to a certain extent capable of predicting high and very high CV risk.


 





 

-CRP và
IL-

-CRP và IL-


U

 




 -CRP và IL-6.
2.3. Ni dung nghiên cu: Ch ng yu t 
i lon Lipide máu theo hi Tim mch Ving, tha cân, béo
phì theo tiêu chun ci lon Glucose máu
a theo tiêu chun Hng M ng hs-
 c phn ng kháng nguyên kháng th trên ht latex, thc hin trên máy OLYMPUS OSR
ng IL-6 theo nguyên lý phn ng min dch tun t quang hóa gn enzyme phase
c, thc hin trên máy IMMULITE ci BVTW Hu.

 liu: Phn mm Excel 2003 (So sánh tr trung bình; So sánh t
l; Phân tích hi quy tuyn tính); Phn mng cong ROC; Tính
h s ); Phn mm SPSS 11.5 (Phân tích hi quy Logistic).


-CRP và IL-
 -CRP (mg/l) và IL-6 


(n = 41)

(n = 99)
t
p
hs-CRP (
X
 SD)
1,97  1,93
3,68  2,62
4,229
< 0,0001
IL-6

9,5
(4,1 - 12)
9,8
(6,2 - 13,4)
2,202
0,0310
THA n

-CRP và IL-
-CRP và IL-


AUC
(95% CI)


Sp
(95% CI)
Se
(95% CI)
p
hs-CRP
(mg/l)
0,708
(0,625  0,781)
2,01 mg/l
80,5
(65,1  91,2)
63,6
(53,4  73,1)
< 0,0001
IL-6
(pg/ml)
0,561
(0,475 - 0,645)
4,6 pg/ml

29,3

(16 - 45,5)
88,9
(81 - 94,3)
0,2447
- 0,0001).
Trong khi IL-6 thì không (p = 0,2447).
. -
hs-CRP
(mg/l)




2

p
n
%
n
%
n
%
24,62
< 0,0001
> 2,01
8
19,5
27
56,3
36

70,6
 2,01
33
80,5
21
43,7
15
29,4

41
100
48
100
51
100
-
2,01mg/l), p < 0,0001.
. -
theo JNC 6.
IL-6
(pg/ml)




2

p
n
%

n
%
n
%
7,78
0,0204
> 4,6
29
20,7
41
29,3
47
33,6
 4,6
12
8,6
7
5,0
4
2,8

41
29,3
48
34,3
51
36,4
-t 4,6
pg/ml), p = 0,0204.
-CRP và IL-


3.2.1. 
 -CRP (mg/l) và IL-






t
p
hs-CRP (
X
 SD)
1,75  1,41
3,84  2,69
6,023
< 0,0001
-6

8,9
(3,4 - 12)
9,8
(6,3 - 13,4)
2,292
0,0249
-CRP và IL-

0,0001 và p = 0,0249).
hsCRP

0 20 40 60 80 100
100
80
60
40
20
0
100-Specificity
Sensitivity
Sensitivity: 55.2
Specificity: 88.6
Criterion : >2.9

 -
 -


(mg/l)
Se
Sp
PPV
NPV
%
95% CI
%
95% CI
%
95% CI
%
95% CI

1
86
78 - 93
34
21 - 50
74
65 - 82
54
34 - 73
2,9
55
45 - 65
89
75 -96
91
81 - 97
48
36 - 59
4
45
35 - 55
93
81 - 99
94
92 - 97
44
33 - 54
- -CR
-


        hs-       

hs-CRP
(mg/l)




2

p
n
%
n
%
n
%
29,54
< 0,0001
> 2,9
5
11,4
23
44,2
30
68,2
 2,9
39
88,6
29

55,8
14
31,8

44
100
52
100
44
100
-

IL6
0 20 40 60 80 100
100
80
60
40
20
0
100-Specificity
Sensitivity
Sensitivity: 95.8
Specificity: 29.5
Criterion : >3.5

 -

-  IL-


-CRP và IL-

 -CRP (mg/l) và theo IL-




các YTNC khác
OR
95% CI
p
OR
95% CI
p
hs-
9,6
3,5 - 27
0,0001
10,7
3,7 - 31
< 0,0001
IL-
9,6
2,9 - 32
< 0,0001
9,6
2,6 - 35
0,0007
      -CRP và IL- 


3-

 -CRP
hs-CRP




P
0

p
e


95% CI

> 2,9
53
5
0,66
0,47
0,36
0,21 - 0,5
 2,9
43
39
-
 = 0,36).


-CRP và IL-
-CRP và IL- hs-
                   
-- - 
-
(95% CI) là 0,708 (0,625 - -
-
-
-CRP, 
2
= 24,64, p < 0,0001 -
- -
. -6
-6, 
2
= 7,78; p = 0,0204
. 
-CRP và IL-6.



-

-
0,01) [1].
4.2-CRP và IL-
-CRP và IL-
-CRP và IL-
có .

-
có AUC (95% CI) là 0,746 (0,666 - 
  - -


-CRP, 
2
= 29,54, p < 0,0001 
 -
- 0,5)  
-
cao.
-
AUC (95% CI) là 0,572 (0,486 - 0,656), p = 0,1565  - -

-CRP = 2,9 mg/l và IL-
hs-CRP và IL-,5 - 26,5) và 9,6
(2,9 - -
-CRP và 9,6 (2,6 - -6 . 
-CRP -
- 


 -
-
-

-
-CRP > 3 mg/l cho phép 








-
[10].
-6 và
Fibrinogen tron                
- 

-

IL-nh và NMCT trong


                -CRP theo
-CRP
-CRP 1 - 
--CRP > 3mg/l thì HR = 1,52; CI
96%: 1,15-2,02; p = 0,003 [8].


-CRP và IL-6.
2) --
-

1.  


- 
2. 

-291.
3. International Diabetes Federation/WHO (2006), Definition and diagnosis of diabetes
mellitus and intermediate hyperglycemia.
4. Luc G; Bart J-M; Juhan-Vague (2003), C-Reactive Protein, Interleukin-6, and Fibrinogen
as Predictors of Coronary Heart Disease, Arteriosclerosis, Thrombosis, and Vascular
Biology 23:1255.
5. Pauletto P.; Rattazzi M. (2006), Inflammation and hypertension: the search for a link,
Nephrology Dialysis Transplantation 21(4);850-853.
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Cardiovascular Disease: Application to Clinical and Health Practice: A Statement for
Healthcare Professionals From the Centers for Disease Control and Prevention and the
American Heart Association, Circulation 107:499.
7. Ryan MJ (2007), Role of Cytokines and Inflammation in Hypertension, Comprehensive
Hypertension, pp. 229-240.
8. Sabatine M.S.; Morrow D.A.; Jablonski K.A. (2007), Prognostic Significance of the
Centers for Disease Control/American Heart Association High-Sensitivity C-Reactive
Protein Cut Points for Cardiovascular and Other Outcomes in Patients With Stable
Coronary Artery Disease, Circulation 115:1528-1536.
9. Sung K.C.; Suh J.Y.; Kim B.S (2003), High Sensitive C-Reactive Protein as an
Independent Risk Factor for Essential Hypertension, Am J Hypertens 16, 429-433.
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Cardiovascular Disease: An Update, Clin Chem Lab Med 39(11): 1054-1064.
11. WPRO [2000], The Asia-Pacific Perspective: Redefining Obesity and its treatment.