累积平均动脉压对全因死亡的预测价值

The predictive value of cumulative mean arterial pressure on all-cause death

目的 探讨累积平均动脉压（cumMAP）对全因死亡的预测价值。方法 选择参加2006-2007、2008-2009及2010-2011年度健康体检且资料完整的开滦集团在职及离退休职工56 039人作为观察对象,进行了平均4.92年的随访,每年通过开滦社会保障信息系统获取死亡信息。cumMAP计算公式为[（MAP_1＋MAP_2）/2×time_（1-2）]＋[（MAP_2＋MAP_3）/2×time_（2-3）],其中MAP_1、MAP_2、MAP_3分别为根据第1、2、3次体检血压值计算的平均动脉血压,time1-2、time2-3为相邻两次体检血压测量的时间间隔。将研究对象按cumMAP四分位分成4组,比较各组全因死亡率的差异,并采用多因素Cox比例风险模型分析cumMAP与全因死亡的关系。结果 在平均4.92年随访期内共有1805例（3.2%）发生全因死亡。cumMAP第1~4四分位组全因死亡率分别为1.1%、2.3%、3.8%、5.6%（P〈0.01）。多因素Cox回归分析结果显示,在校正包括基线收缩压、平均动脉压在内的多种混杂因素后,与第1四分位组相比,第2、3、4四分位组发生全因死亡的HR值（95%CI）分别为1.17（0.95~1.43）、1.32（1.08~1.61）和1.34（1.09~1.65）。结论 cumMAP是全因死亡的独立危险因素。

Objective To examine the predictive value of cumulative mean arterial pressure（cumMAP） on all-cause death（ACD）. Methods A total of 56 039 subjects who had participated 2006-2007, 2008-2009 and 2010-2011 health examinations and had sufficient data were included in the study and followed up for an average of 4. 92 years. The information of death in all subjects was collected annually through the Kailuan Social Security Information Sys- tem. cumMAP was calculated using following formula： eumMAP=[（MAP1 ＋MAPs ）/2 × timel-2]＋[（MAP2 ＋ MAPs ）/2×time2-3], where MAP1, MAP2, MAPs indicated MAP at examination 1, 2, 3, and timel-s, time2-s repre- sented participant-specific time interval between consecutive examinations. Subjects were divided into four groups based on the quartiles of eumMAP. The incidence of all-cause death among four groups were compared and the cor- relation between cumMAP and all-cause death was analyzed by multivariate Cox proportional hazard regression. Results During a median follow-up of 4.92 years, 1805 eases all-cause death occurred, accounted for 3.2%. The all-cause mortality was 1.1 %, 2.3 %, 3.8 %, 5.6 % in the first, second, third and fourth quartile group respectively （P〈0.01）. Cox proportional hazard regression analysis showed that after adjusted for other confounding factors, including baseline systolic blood pressure and arterial pressure, compared to the first quartile, the HR （95% CI） of all-cause death in second, third and fourth quartile were 1.17（0.95-1.43）, 1.32（1.08-1.61） and 1.34 （1.09-1. 651. Conclusion eumMAP is an independent risk factor for all-cause death.