糖尿病人群中高敏C反应蛋白与新发心脑血管事件关系的前瞻性研究

Association between baseline high sensitivity C-reactive protein level and the first cardio-cerebral vascular event in diabetic population： a prospective cohort study

目的探讨基线血清高敏C反应蛋白（hsCRP）水平对糖尿病人群新发心脑血管事件的预测价值。方法本研究采用前瞻性队列研究方法，以参加2006年7月至2007年10月健康查体的101510名开滦集团职工中空腹血糖≥7．0mmol／L或〈7．0mmol／L但已确诊为糖尿病，正在使用降糖药物的7865例糖尿病者作为观察队列，随访38～53（48．02±3．14）个月，随访期间每半年收集1次新发心脑血管事件情况。分析基线血清hsCRP水平对糖尿病人群新发心脑血管事件的预测价值。结果（1）随着基线hsCRP水平的增高，发生总心脑血管事件、脑梗死和心肌梗死事件率均逐渐增高，差异有统计学意义（P〈0．01）；多变量Cox比例风险回归分析表明校正年龄、性别、收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、体质指数及吸烟因素后，基线hsCRP最高四分位数组（hsCRP≥2．50mg／L）发生总心脑血管事件、脑梗死和心肌梗死的相对危险（RR）分别为最低四分位数组（hsCRP〈0．41mg／L）的1．64倍（95％CI：1．20～2．24，P：0．002），1．52倍（95％CI：1．03—2．24，P=0．034）和2．57倍（95％CI：1．34～4．91，P=0．004）。（2）随着基线hsCRP水平的增高，研究对象的平均年龄逐渐增高；女性在人群中比例逐渐增多；体质指数、收缩压、舒张压、空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平增高，差异均有统计学意义（P〈0．05）；高密度脂蛋白胆固醇水平降低，差异有统计学意义（P〈0．05）。结论基线hsCRP可预测糖尿病人群发生心脑血管事件，hsCRP水平较高者发生临床心脑血管事件的危险增加，尤其是脑梗死和心肌梗死的危险。

Objective To evaluate the predictive value of baseline serum high sensitivity C-reactive protein for the first cardio-cerebral vascular event in the population with diabetes. Method In this prospective cohort study, a total of 101 510 employees of Kai Luan Group, who received healthy examination from July 2006 to October 2007, were screened and 7865 subjects with fasting plasma glucose ≥ 7.0 mmol/L or known diabetes mellitus and under insulin or hypoglyeemic drugs therapy were followed up for 38 - 53 （48.02 ± 3.14 ） months. Results （ 1 ） Incidence rates of total eardio-cerebral vascular events, cerebral infarction and myocardial infarction increased in proportion to increased levels of baseline hsCRP （P 〈 0. 01 ）. After adjusting for age, gender, body mass index （BMI）, systolic blood pressure（ SBP）, diastolic blood pressure （DBP）, total cholesterol（TC）, triglyeeride（TG）, low-density lipoprotein cholesterol （LDL- C）, high-density lipoprotein cholesterol （HDL-C） and cigarette smoking, multivariate Cox＇s proportional hazards regression analysis indicated that the individuals in the highest quartile of hsCRP levels group （hsCRP≥2. 50 mg/L） had an increased risk of total cardio-cerebral vascular events （RR： 1.64, 95% CI： 1.20 -2. 24）, cerebral infarction （RR： 1.52, 95% CI： 1.03 -2. 24）, myocardial infarction （RR： 2. 57, 95% CI： 1.34 -4. 91 ） compared with those in the lowest quartile group（ hsCRP 〈 0. 41 mg/L）. （2） Higher baseline hsCRP levels were associated with aging, female gender, higher BM/, SBP, DBP, fasting blood glucose, TC, TG, LDL-C levels and lower HDL-C levels （ all P 〈 0. 05 ）. Conclusion Baseline hsCRP level is associated with increased first cardio-cerebral vascular event in the population with diabetes.