糖尿病与发炎指标CRP.课件

按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,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:From Acute Phase Protein to Cardiovascular disease,CRP is a symmetrical ring molecule that consists,of 5,noncovalent,but associate,protomers,.Each,protomer,has,2 calcium ions,responsible for the specific binding of,phosphochlorine,.,Phosphochlorine,is a,common constituent,of many bacterial and fungal polysaccharides,and,most biologic cell membranes,such as the,phosphochlorine,residues of,C(or capsular)-polysaccharide of,Streptococcus,pneumoniae,.,The protein was named“C-reactive”because of this reaction.,A stable,pentameric,protein-compound with a half-life of 19 hours,without diurnal variation,CRP is a pathogenic marker and a nonspecific marker of inflammation.CRP is synthesized in response to the,acute phase of a bacterial or fungal infection,.,Molecular Structure and Morphology of Human CRP,Negatively stained electron micrograph showing the typical,pentameric,disc-like structure face-on and side-on(arrows).,Ribbon diagram of the crystal structure,showing the,lectin,fold and the two calcium atoms(spheres)in the,ligand,-binding site of each,protomer,.,Space-filling model of the CRP molecule,showing a single,phosphocholine,molecule located in the,ligand,-binding site of each,protomer,).,Pepys,MB,et al.,Clin,Invest 2003;111:1805-1812.,Assays of CRP and Reference Ranges,During the acute phase of infection,serum CRP levels were measured by,rate,nephelometry,(“serum CRP assay”).These assays have a lower limit of detection of only,6 to 10 mg/l.,A more sensitive,latex particle-enhanced,immunoturbidimetric,assay(“high sensitivity,hs,-CRP assay”),has been developed that has a lower limit of detection(or sensitivity)of,about 0.15 mg/l,.It is used to assess for cardiovascular risk.,The risk factors by,hs,-CRP levels(CDC,AHA):,CRP,1 mg/l,is low CVD risk,CRP 1 to 3 mg/l,is moderate CVD risk,CRP 3 to 10 mg/l,is high CVD risk,CRP levels,10 mg/l,generally indicates bacterial infection,Demographic and Descriptive Characteristics of the,US Population Without a Previous Diagnosis of,Hypertension From NHANES III,Matthias B.et al.Diabetes Care 2004;27:1680-1687.,140 180,mg/,dL,WOSCOPS:Overlap Analysis,Frequency per 100,On treatment LDL,n Events,1120 108,1071 67,Placebo,Pravastatin,RR on,Pravastatin,=0.65,Log rank p=0.002,Adjust for on-treatment LDL,HDL,VLDL,TG&baseline covariates.,RR on,Pravastatin,=0.64,p=0.014,77,155,116,194,232,mg/,dL,WOSCOPS Group.Circulation.1998;97:1440-45,The Effects of,Atorvastatin,versus,Simvastatin,on Atherosclerosis Progression Study,(,ASAP,),Atorvastatin,reduced CRP levels to a greater extent than,simvastatin,van,Wissen,S,et al.,Atherosclerosis,.2002;165:361-366.,*,P,0.001 for difference between groups;*,P,=0.02 for difference between groups,*,*,-50,-45,-40,-35,-30,-25,-20,-15,-10,-5,0,1 Year,2 Years,Atorvastatin,Simvastatin,Percent change in,hs,-CRP,-44.9,-14.0,-40.1,-19.7,Influence of Baseline BMI on Ability of,Atorvastatin,to Modify CV Risk Factors(REVERSAL Study),P0.01,P0.01,P30),Thrombogenic/hemostatic,state,Atherogenic diet,Non-modifiable,Age,Male sex,Family history of premature CHD,National Cholesterol Education Program Adult Treatment Panel III.2002.NIH Publication No.02-5215.,Factors Associated with Increased or Decreased CRP,Higher CRP,Hypertension,Hyperglycemia,Low HDL/high TG,Smoking,Obesity,Metabolic syndrome,Estrogen/progesterone use,Chronic infection,Lower CRP,Increase exercise,Alcohol consumption,Weight loss,Medication:,Statin,Fibrate,Hypertension and,Dyslipidaemia,Are Major Risk Factors for CHD,Kannel,W.In:Hypertension:,Pathophysiology,and Treatment.New York:McGraw-Hill,Inc.;1977:888-909;,Castelli,WP.Am J Med.1984;76:4-12.,CHD incidence/1000,Probability of CVD/1000,Age,40,50,60,70,Framingham study,SBP(mm Hg)in men,TC(mg/,dL,)in men,Concomitant Hypertension and Dyslipidemia Increase the Risk of Developing Fatal CVD,Adapted from De Backer G et al.,Eur,J,Cardiovasc,Prev,Rehabil,.,2003;10(,suppl,1):S1-S78.,Dyslipidemia,Hypertension,Dyslipidemia/Hypertension,TC 271 mg/,dL,(7,mmol,/L),SBP 180 mm Hg,TC 271 mg/,dL,(7,mmol,/L),SBP 180 mm Hg,Hypertension and High Cholesterol are Twice as Prevalent in Adults with DM Compared to those without DM,Archives of Internal Medicine 2002;162:427-433,*,P0.001,Hypertension and Dyslipidemia Commonly Occurs in Diabetes in Taiwan,TADE 2002,Prevalence(%),High uric acid,Dyslipidemia,Obesity,Hypertension,C,反應蛋白,(CRP),可加強,TC/HDL,比值預估首度心肌梗塞發生之風險,Ridkor,PM.Circulation 1996;97:2007-11.,冠,心,病,風,險,TC/HDL,比值,CRP,C-RP(mg/L),0 1 2 3 4,N=1,008,代謝異常數目,代謝異常包括：,肥胖,高血壓,高三酸甘油脂症,低,HDL-C,高胰島素血症,Festa,et al.Circulation 2000;102:42-7.,C,反應蛋白,(CRP),與,代謝異常數目,Insulin Resistance Atherosclerosis Study,5,4,3,2,1,P0.001,Albert MA,et al.Circulation.2003;107:443,Alcohol Consumption and Plasma C-RP,Many Assays Developed Before,hs,-CRP Are More Sensitive Than“,hs,-CRP Assay”,As early as 1981,a solid-phase single-antibody competitive radioimmunoassay with a single rabbit anti-CRP antibody directly immobil