Pedersen Kasper Mønsted, Çolak Yunus, Hasselbalch Hans Carl, Ellervik Christina, Nordestgaard Børge Grønne, Bojesen Stig Egil
Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark.
The Copenhagen General Population Study, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark.
EClinicalMedicine. 2020 Apr 6;21:100295. doi: 10.1016/j.eclinm.2020.100295. eCollection 2020 Apr.
High cardiovascular comorbidity contributes to excess mortality in patients with myeloproliferative neoplasm, while less is known about respiratory comorbidity and mortality. We tested the hypothesis that individuals with myeloproliferative neoplasm have increased risk of pneumonia and respiratory mortality.
Of 249 294 invited individuals aged ≥20 from the Danish general population from 2003-2015, 107 900 participated and were included in the Copenhagen General Population Study (response-rate: 43%). We examined lung function and respiratory symptoms at baseline examination and followed individuals prospectively from baseline examination through 2018 to determine risk of pneumonia and respiratory mortality using Cox proportional hazard regression. Among 351 individuals with myeloproliferative neoplasm, 131 (37%) were diagnosed at baseline examination and 220 (63%) were diagnosed during follow-up. The follow-up cases were entered in the regression analysis by using a time-varying variable.
In total, 125 (36%) individuals had essential thrombocythaemia, 124 (35%) had polycythaemia vera, and 102 (29%) had myelofibrosis/unclassifiable myeloproliferative neoplasm. During follow-up we observed 5979 pneumonias and 2278 respiratory deaths. Compared to individuals without myeloproliferative neoplasm, multivariable adjusted hazard ratios in individuals with myeloproliferative neoplasm were 2·18 (95% CI: 1·60-2·96) for pneumonia and 2·27 (1·46-3·53) for respiratory mortality. Corresponding hazard ratios were 1·26 (0·71-2·30) and 0·96 (0·31-2·94) for essential thrombocythaemia, 2·50 (1·57-3·98) and 3·58 (1·94-6·59) for polycythaemia vera, and 3·03 (1·86-4·93) and 2·40 (1·11-5·19) for myelofibrosis/unclassifiable myeloproliferative neoplasm, respectively. Results were similar in those with and without airflow limitation, and in never-smokers and ever-smokers separately.
Individuals with myeloproliferative neoplasm had two-fold increased risk of pneumonia and respiratory mortality, mainly due to polycythaemia vera and myelofibrosis/unclassifiable myeloproliferative neoplasm. These are novel findings.
心血管合并症高发导致骨髓增殖性肿瘤患者死亡率过高，而关于呼吸合并症及死亡率的了解较少。我们检验了骨髓增殖性肿瘤患者患肺炎及呼吸相关死亡风险增加这一假设。
在2003年至2015年丹麦普通人群中邀请的249294名年龄≥20岁的个体中，107900名参与并纳入哥本哈根普通人群研究（应答率：43%）。我们在基线检查时检测了肺功能和呼吸道症状，并对个体从基线检查开始进行前瞻性随访直至2018年，使用Cox比例风险回归确定肺炎和呼吸相关死亡风险。在351名骨髓增殖性肿瘤患者中，131名（37%）在基线检查时被诊断，220名（63%）在随访期间被诊断。随访病例通过使用时变变量纳入回归分析。
总共125名（36%）个体患有原发性血小板增多症，124名（35%）患有真性红细胞增多症，102名（29%）患有骨髓纤维化/无法分类的骨髓增殖性肿瘤。随访期间，我们观察到5979例肺炎和2278例呼吸相关死亡。与无骨髓增殖性肿瘤的个体相比，骨髓增殖性肿瘤患者肺炎的多变量调整风险比为2.18（95%置信区间：1.60 - 2.96），呼吸相关死亡的风险比为2.27（1.46 - 3.53）。原发性血小板增多症相应的风险比为1.26（0.71 - 2.30）和0.96（0.31 - 2.94），真性红细胞增多症为2.50（1.57 - 3.98）和3.58（1.94 - 6.59），骨髓纤维化/无法分类的骨髓增殖性肿瘤分别为3.03（1.86 - 4.93）和2.40（1.11 - 5.19）。在有气流受限和无气流受限的个体中，以及从不吸烟者和曾经吸烟者中分别进行分析，结果相似。
骨髓增殖性肿瘤患者患肺炎和呼吸相关死亡的风险增加了两倍，主要归因于真性红细胞增多症和骨髓纤维化/无法分类的骨髓增殖性肿瘤。这些是新发现。
