社区人群C反应蛋白水平与高血压关系的前瞻性研究

The prospective study of association between C-reactive protein and hypertension in community population

目的 探讨基线血压正常人群的高敏C反应蛋白（hs-CRP）水平与随访期间高血压发病风险的关系.方法 以2000年4月“江苏省多代谢异常和代谢综合征综合防治研究”建立的队列人群为基础.在2006年6月开始对其中调查满5年者进行随访,共随访到2035名研究对象,测定其血中hs-CRP.将基线血压正常者按hs-CRP值进行四分位分组（＜1.3、1.3～1.9、2.0 ～3.2和≥3.3 mg/L组,分别为514、498、515、508名）,采用Cox风险比例回归模型分析不同水平hs-CRP、基线血压与高血压发病风险的关联.结果 2035名研究对象（男926名,女1109名）中位随访时间为6.39人年.hs-CRP＜1.3、1.3～1.9、2.0～3.2和≥3.3 mg/L组的高血压的发病率分别为2378/10万人年、2942/10万人年、3693/10万人年、4390/10万人年.调整性别、年龄、基线血压、BMI、吸烟、饮酒、体力活动、心肌梗死和糖尿病家族史等因素后,与hs-CRP＜ 1.3 mg/L相比,hs-CRP为1.3～1.9、2.0～3.2和≥3.3 mg/L组的RR（95％ CI）值分别为1.22（0.87～ 1.72）、1.43（1.03 ～2.00）和1.70（1.21～2.41）.将基线血压四分位分层后,仍然发现各组的高血压发病率随着hs-CRP水平的增高而增高,在基线SBP＜110 mm Hg（1 mm Hg=0.133 kPa）组,与hs-CRP＜1.3 mg/L相比,hs-CRP为1.3～1.9、2.0～3.2和≥3.3 mg/L组的RR（95％ CI）值分别为2.24（1.32 ～4.03）、2.57（1.57 ～4.57）、3.57（2.54 ～5.90）;在基线DBP＜65 mm Hg组,RR（95％CI）值分别为1.78（1.03～3.24）、2.74（1.63 ～4.93）、4.13（2.35 ～7.27）.结论 炎症是高血压形成发展机制中的一个重要环节.

Objective The aim was to explore the association between high-sensitivity C-reactive protein level at baseline and hypertension in follow-up periods in a Chinese cohort.Methods We analyzed data from a cohort established in ＂Prevention of metabolic syndrome and multi-metabolic disorders in Jiangsu province＂ in April 2000.A follow-up investigation was carried out for those whose follow up time met 5 years in June 2006.A total of 2035 persons completed investigation and hs-CRP was tested.Subjects with normal baseline blood pressure were classified into four groups （514,498,515 and 508 subjects in each group） according to quartiles of hs-CRP level （＜ 1.3,1.3-1.9,2.0-3.2 and ≥3.3 mg/L）.The relationship between the risk of hypertension and baseline level of hs-CRP were analyzed using Cox proportional hazards regression model.Results The median of follow up time was 6.39 years among the 2035 subjects （926males and 1109 females）.Hypertension incidence was 2378/100000 person-years,2942/100000 personyears,3693/100000 person-years and 4390/100000 person-years in hs-CRP ＜ 1.3,1.3-1.9,2.0-3.2and ≥3.3 mg/L groups respectively.Compared to the group of hs-CRP ＜ 1.3 mg/L,the relative risk （RR）（95％ CI）of hypertension in groups of hs-CRP 1.3-1.9,2.0-3.2 and ≥3.3 mg/L was 1.22（0.87-1.72）,1.43（1.03-2.00）,1.70（1.21-2.41） respectively,adjusted for sex,age,baseline blood pressure,BMI,smoking,alcohol drinking,physical activitv and family history of myocardial infarction and diabetes.When stratified by quartiles of baseline blood pressure,the incidence of hypertension in each group increased with level of hs-CRP.In the group whose baseline SBP ＜ 110 mm Hg（1 mm Hg =0.133 kPa）,compared to the group of hs-CRP＜1.3 mg/L,RR（95％CI） were 2.24（1.32-4.03）,2.57（1.57-4.57） and 3.57 （2.54-5.90） in hs-CRP 1.3-1.9,2.0-3.2 and ≥ 3.3 mg/L groups respectively.In the group whose baseline DBP ＜ 65 mm Hg,RR（95％ CI） were 1.78 （1.03-3.24）,2.74 （1.63-4.93） and 4.13 （2.35-7.27） respectively.Conclusion Inflammation was an important process in the development of hypertension.