高敏C反应蛋白（hsCRP）、心血管事件与老年人死亡率：一项为期9年的前瞻性随访研究。
High sensitive C-reactive protein (hsCRP), cardiovascular events and mortality in the aged: a prospective 9-year follow-up study.
作者信息
Kuoppamäki Marikka, Salminen Marika, Vahlberg Tero, Irjala Kerttu, Kivelä Sirkka-Liisa, Räihä Ismo
机构信息
Institute of Clinical Medicine, Family Medicine, University of Turku, Turku, Finland; Naantali Health Centre, Naantali, Finland.
Institute of Clinical Medicine, Family Medicine, University of Turku, Turku, Finland; Härkätie Health Centre, Lieto, Finland; Unit of Family Medicine, Turku University Hospital, Turku, Finland.
出版信息
Arch Gerontol Geriatr. 2015 Jan-Feb;60(1):112-7. doi: 10.1016/j.archger.2014.10.002. Epub 2014 Oct 13.
OBJECTIVE
The clinical utility of application of hsCRP categorization and the association of hsCRP with vascular disease (VD) events are less studied among the aged. This study investigated whether an elevated hsCRP has an additive effect on conventional vascular risk factors in predicting cardiovascular morbidity and all-cause mortality among the aged.
METHODS AND RESULTS
a prospective population-based study with a 9-year follow-up among persons aged ≥64 and without VD and C-reactive protein (CRP)<10mg/L at baseline (n=771). Adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) for VDs and all-cause mortality predicted by hsCRP level were estimated. During the follow-up, there were 151 major VD events, and 217 subjects died. After the adjustment for age and gender or risk factors related to VD events or a metabolic syndrome (MetS), hsCRP was not related to incident VD events (HR 1.14, 95% CI 0.96-1.35, p=.127 or 1.11, 0.94-1.32, p=.212, respectively). hsCRP predicted all-cause mortality after the adjustment for age and gender (1.18, 1.03-1.36, p=.020) and multiple factors (1.16, 1.00-1.33, p=.046) but not beyond conventional risk factors. High risk participants (hsCRP 3.0-9.9mg/L) had higher age and gender adjusted (1.50, 1.07-2.10, p=.018) and tended to have higher risk factor adjusted all-cause mortality (1.41, 1.00-2.00, p=.052) compared with low risk participants (hsCRP<1mg/L).
CONCLUSIONS
hsCRP may not be useful in prediction of cardiovascular events.
目的
在老年人中，高敏C反应蛋白（hsCRP）分类应用的临床效用以及hsCRP与血管疾病（VD）事件的关联研究较少。本研究调查了hsCRP升高在预测老年人心血管疾病发病率和全因死亡率方面是否对传统血管危险因素具有附加作用。
方法与结果
一项基于人群的前瞻性研究，对年龄≥64岁、基线时无VD且C反应蛋白（CRP）<10mg/L的人群进行了9年随访（n = 771）。估计了hsCRP水平预测VD和全因死亡率的校正风险比（HR）及其95%置信区间（CI）。随访期间，发生了151例主要VD事件，217名受试者死亡。在调整年龄和性别或与VD事件或代谢综合征（MetS）相关的危险因素后，hsCRP与VD事件的发生无关（HR分别为1.14，95%CI 0.96 - 1.35，p = 0.127或1.11，0.94 - 1.32，p = 0.212）。hsCRP在调整年龄和性别（1.18，1.03 - 1.36，p = 0.020）以及多种因素（1.16，1.00 - 1.33，p = 0.046）后可预测全因死亡率，但超出传统危险因素后则不然。与低风险参与者（hsCRP<1mg/L）相比，高风险参与者（hsCRP 3.0 - 9.9mg/L）在调整年龄和性别后全因死亡率更高（1.50，1.07 - 2.10，p = 0.018），且在调整危险因素后全因死亡率有升高趋势（1.41，1.00 - 2.00，p = 0.052）。
结论
hsCRP可能对预测心血管事件无用。
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