背景 文獻報告心臟衰竭病人血中C-反應蛋白會增高，但其升高是否有臨床意義則了解有限。吾人假設心臟衰竭病人血中C-反應蛋白增高具有臨床預後指標之意義。方法 吾人測量72位左心室射出分率（left ventricular ejection fraction）小於50%之慢性穩定心臟衰竭病患血中C-反應蛋白數值，追蹤其是否發生重大心臟事件（死亡及因心臟衰竭惡化再入院），並分析其預後。吾人並用多變數分析研究影響這些心臟衰竭病患預後之獨立變項。結果 72位心臟衰竭病患血中C-反應蛋白數值顯著高於對照組正常人，且與心臟衰竭嚴重程度有關。發生重大心臟事件之25位患者其血中C-反應蛋白值亦顯著高於未發生重大心臟事件之47位患者（p值為0.0065）。吾人進一步將病患依血中C-反應蛋白數值高低等分為三組，三組之分界點分別是?2.69，> 2.69 ? 5.38，及>5.38 mg/L，並分析其存活曲線。結果發現C-反應蛋白數值較低之兩組間無顯著差異，但C-反應蛋白數值最高之第三組其發生之重大心臟事件數與前兩組相比則顯著較多（p值分別為0.0048及p = 0.0103）。多變數分析研究（病人數58人）發現左心室舒張末期壓力（僅58位病患有此數值）及C-反應蛋白數值> 5.38 mg/L是影響心臟衰竭病患預後之獨立變項，且兩者間相關性有統計意義（r值為0.26，p值為0.048；病人數58人）。結論 吾人之研究顯示心臟衰竭病患血中C-反應蛋白數值升高與臨床心臟衰竭嚴重程度和預後有關。測量慢性穩定心臟衰竭病患血中C-反應蛋白數值應有助於輔助評估心臟衰竭患者之預後。

Background: Serum concentrations of C-reactive protein (CRP) are elevated in patients with congestive heart failure (CHF). However, clinical data about the prognostic value of CRP levels in patients with chronic stable CHF are spare. We hypothesized that measurement of CRP might provide prognostic information in these patients. Methods: We measured serum levels of CRP in 72 patients with chronic CHF and left ventricular ejection fraction (LVEF) ＜50%. Major adverse cardiac events (death or hospitalization with worsening CHF) during a median follow-up period of 449 days were determined. Multivariate Cox regression analysis was performed to identify independent predictors of major adverse cardiac events. Results: The concentrations of CRP in the sample population were significantly increased with the severity of CHF. The 25 patients who had adverse events had significantly higher CRP levels (p = 0.0065) than the 47 patients who were event-free. We further divided the 72 CHF patients into tertiles on the basis of this sample, with the cutoff points for each tertile being ?2.69, ＞ 2.69 to ? 5.38, and ＞5.38 mg per liter, respectively. The differences between event-free curves were insignificant between tertiles 1 and 2 but were significant between tertiles 1 and 3 and between tertiles 2 and 3 (p = 0.0048, p = 0.0103, respectively). In a multivariate analysis (n =58), left ventricular end-diastolic pressure (LVEDP) and serum levels of CRP ＞ 5.38 mg per liter were found to be independently significant predictors for major adverse cardiac events in patients with chronic CHF. The CRP levels were significantly correlated with LVEDP (r = 0.26, p = 0.048; n=58). Conclusions: These findings suggest that the levels of CRP are related to clinical outcomes and that measurement of CRP has the potential to play an important role as an adjunct for risk assessment in patients with chronic CHF.