中国中年人群超敏C反应蛋白与心血管事件、总死亡事件的关联研究

Association between high-sensitivity C-reactive protein and both cardiovascular, total mortality events in middle-aged Chinese adults

目的 了解超敏C反应蛋白（hs-CRP）与心血管事件、全因死亡事件是否独立相关。方法 2009-2010年在我国12个研究地区各抽取35~64岁调查对象1 000人，实际入选11 623人。收集清晨空腹血标本检测hs-CRP，同时调查心血管病危险因素。2016-2017年对12个地区中的7个地区进行随访，中位随访时间为6.21年（36 075人年），并记录心血管和死亡事件。总共随访6 177例，排除基线感染者、未进行hs-CRP检测和体格测量的研究对象后，5 984例纳入最终分析。根据hs-CRP值（mg/L）将人群分为3组（〈1、1~和〉3）。使用Cox比例风险模型，在调整各混杂因素后，探讨hs-CRP与心血管事件及总死亡事件的关联。结果 随访对象平均年龄50.2岁。hs-CRP〈1、1~和〉3 mg/L 3组人群心血管事件的发生率分别为3.6/1 000人年、7.1/1 000人年和10.4/1 000人年；全因死亡事件发生率分别为3.0/1 000人年、5.7/1 000人年和9.1/1 000人年。调整混杂因素后，与hs-CRP〈1 mg/L组相比，hs-CRP 1~和〉3 mg/L明显增加心血管事件的发生风险，HR值（95% CI）分别为1.33（0.95~1.84）和1.76（1.20~2.60），呈明显上升趋势（趋势检验P=0.003）；发生全因死亡风险也明显增加，HR值（95% CI）分别为1.76（1.23~2.54）和2.64（1.74~4.01），呈明显上升趋势（趋势检验P〈0.001）。结论 hs-CRP增高与心血管事件及全因死亡事件呈独立相关。

Objective To estimate the association between high-sensitivity C-reactive protein （hs-CRP） and cardiovascular events as well as all-cause mortality events. Methods During 2009-2010, out of the 11 623 individuals, 1 000 participants aged 35-64 years, were recruited and divided into 12 age-groups, to have received a study on CVD risk factors. Information on the risk factors of cardiovascular diseases was also collected. Fasting blood sample was gathered for all the participants, with hs-CRP tested. Participants in 7 out of the 12 sites were followed, with 6.21 years （36 075 person-years） as the median follow-up period. Cardiovascular and all-cause mortality events were collected. A total of 6 177 participants had been followed after excluding participants who had baseline infections, or did not take hs-CRP test/physical examination at the baseline. Finally, 5 984 participants were included for analysis. Participants were categorized into three groups based on the hs-CRP （mg/L） values：〈1, 1-3 and 〉3, respectively. Cox proportional hazards regression model was used to analyze the relationships between hs-CRP with cardiovascular events or all-cause mortality events, after adjusting for confounding factors. Results Mean age of the participants was 50.2 years. The incidence rates of cardiovascular disease events were 3.6/1 000 person-years, 7.1/1 000 person-years, and 10.4/1 000 person-years among three groups and 3.0/1 000 person-years, 5.7/1 000 person-years, 9.1/1 000 person-years for all-cause mortality events, respectively. After adjusting for confounding factors, the hazard risks （HR） for cardiovascular events were 1.33 （95% CI：0.95-1.84） in the hs-CRP 1-3 mg/L group and 1.76 （95% CI：1.20-2.60） in the hs-CRP〉3 mg/L group when comparing with the hs-CRP〈1 mg/L group （trend test P=0.003）. The HRs for all-cause mortality events were 1.76 （95% CI：1.23-2.54） and 2.64 （95% CI：1.74-4.01） （trend test P〈0.001）, respectively. Conclusion Hs-CRP appeared an independent predictor for cardiovascular events and all-cause mortality events.