炎性因子水平与肺癌发病风险的前瞻性队列研究

The relationship between inflammatory markers and the risk of lung cancer: a prospective cohort study

目的探讨C-反应蛋白(CRP)和中性粒细胞(NE)与肺癌发病风险的关联性。方法利用2006-2007年以开滦(集团)有限责任公司全体在职及退休职工为研究对象建立的开滦队列,随访至2015年12月,收集肺癌新发病例资料,采用多因素Cox比例风险模型评估基线CRP和NE水平与肺癌发病风险的关系。结果92 735人被纳入研究,随访期间共新发肺癌850例。依据基线CRP和NE水平,将研究人群分为CRP≤3 mg/L且NE≤4×109/L组(A组)、CRP≤3 mg/L且NE>4×10^9/L组(B组)、CRP>3 mg/L且NE≤4×10^9/L组(C组)和CRP>3 mg/L且NE>4×10^9/L组(D组)。4组肺癌累积发病率分别为950/10万、1 030/10万、1 081/10万和1 596/10万,差异有统计学意义(P<0.001)。多因素Cox比例风险模型回归分析显示,以A组(CRP与NE水平最低)为参照,D组(CRP与NE水平最高)肺癌发病风险增高72%(95%CI为1.40~2.12,P<0.001)。按照性别进行分层分析显示,男性D组的肺癌发病风险是A组的1.73倍(95% CI为1.40~2.15,P<0.001)。结论基线CRP和NE水平升高可能增加肺癌的发病风险。

Objective To investigate whether elevated levels of C-reactive protein (CRP) and neutrophil (NE) in the blood is associated with an increased risk of lung cancer incidence. Methods From 2006 to 2007, all employees and retirees from Kailuan (Group) Limited liability Corporation were included in this Kailuan Cohort study. The last follow-up date was December 2015. Data on new cases of lung cancer were collected, and multivariable Cox proportional hazards regression models were used to the relationship between baseline CRP and NE at baseline and risk of lung cancer. Results A total of 92 735 participants were enrolled in this study. During the follow-up, 850 new cases of lung cancer were identified. All subjects were divided into four groups according to the combination level of CRP and NE at baseline: CRP≤3 mg/L and NE≤4×109/L(Group A), CRP≤3 mg/L and NE>4×10^9/L(Group B), CRP>3 mg/L and NE≤4×10^9/L(Group C), CRP>3 mg/L and NE>4×10^9/L(Group D). The cumulative incidence of lung cancer were 950/100 000, 1 030/100 000, 1 081/100 000 and 1 596/100 000 in these four groups, respectively (P<0.001). Multivariate Cox proportional risk model showed that participants from Group D had an significantly increased 72% risks of lung cancer when compared to Group A (95% CI: 1.40~2.12, P<0.001). Stratified analyses gender showed that males in Group D had higher risk of lung cancer when compared with participants in Group A (HR=1.73, 95% CI: 1.40~2.15, P<0.001). Conclusion Elevated levels of CRP and NE might increase the risk of lung cancer.