hs-CRP/HDL-C比值对普通人群长期死亡率的预测作用：一项队列研究的证据
The predictive role of the hs-CRP/HDL-C ratio for long-term mortality in the general population: evidence from a cohort study.
作者信息
Wang Yifeng, Wang Li, Zhao Zongquan, Yin Song, Tang Xuejun, Zhang Kerui
机构信息
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, 210000, China.
Community Health Center, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, 215000, China.
出版信息
BMC Cardiovasc Disord. 2024 Dec 30;24(1):758. doi: 10.1186/s12872-024-04446-1.
BACKGROUND
The high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) ratio, a composite marker of low-grade inflammation and lipid metabolism, is reportedly associated with the occurrence of new cardiovascular diseases (CVDs) in certain people. However, the predictive value of the hs-CRP/HDL-C ratio for long-term mortality in the general population remains unclear.
METHODS
This retrospective cohort study included data from 9,492 adults obtained from the National Health and Nutrition Examination Survey (NHANES) (2015-2018) in the United States. Multivariate Cox regression, two-piecewise linear regression, restricted cubic spline (RCS) models and subgroup analysis by age, sex, smoking status and drinking status were applied to evaluate the associations of the hs-CRP/HDL-C ratio with long-term all-cause and cardiovascular mortality.
RESULTS
The overall median age of the cohort was 47.0 years (interquartile range (IQR) 32.0-62.0), and 4,585 (48.30%) patients were male. During a median follow-up period of 37.0 months, 239 (2.52%) all-cause deaths occurred, 59 (0.62%) of which were attributed to cardiovascular events. Participants with all-cause and cardiovascular mortality presented a higher hs-CRP/HDL-C ratio than did those without events [0.56 (0.24-1.38) vs. 0.37 (0.14-0.94) and 0.60 (0.23-1.60) vs. 0.37 (0.14-0.95), P < 0.001 and P = 0.002]. According to multivariate Cox regression models, the hs-CRP/HDL-C ratio was found to be an independent risk factor for both long-term all-cause mortality [hazard ratio (HR) = 1.09, 95% confidence interval (CI): 1.05-1.13] and cardiovascular mortality (HR = 1.11, 95% CI: 1.05-1.19). A two-piecewise linear regression model indicated that the risk of all-cause mortality increased more prominently when the hs-CRP/HDL-C ratio was less than 1.21. In addition, a significant interaction effect with smoking status was discovered (P = 0.006), indicating that the association of the hs-CRP/HDL-C ratio with all-cause mortality was stronger in nonsmokers. The RCS curve revealed a positive linear association of the hs-CRP/HDL-C ratio with long-term mortality after adjustment for potential confounders.
CONCLUSIONS
The hs-CRP/HDL-C ratio is a crucial predictor of long-term mortality in the general population, independent of potential confounding factors.
背景
高敏C反应蛋白（hs-CRP）与高密度脂蛋白胆固醇（HDL-C）的比值是一种反映低度炎症和脂质代谢的综合标志物，据报道，在某些人群中，该比值与新发心血管疾病（CVD）的发生有关。然而，hs-CRP/HDL-C比值对普通人群长期死亡率的预测价值仍不明确。
方法
这项回顾性队列研究纳入了来自美国国家健康与营养检查调查（NHANES）（2015 - 2018年）的9492名成年人的数据。应用多变量Cox回归、两段式线性回归、受限立方样条（RCS）模型以及按年龄、性别、吸烟状况和饮酒状况进行的亚组分析，以评估hs-CRP/HDL-C比值与长期全因死亡率和心血管死亡率之间的关联。
结果
该队列的总体中位年龄为47.0岁（四分位间距（IQR）为32.0 - 62.0），4585名（48.30%）患者为男性。在中位随访期37.0个月期间，发生了239例（2.52%）全因死亡，其中59例（0.62%）归因于心血管事件。全因死亡和心血管死亡的参与者的hs-CRP/HDL-C比值高于无事件发生的参与者[0.56（0.24 - 1.38）对0.37（0.14 - 0.94）以及0.60（0.23 - 1.60）对0.37（0.14 - 0.95），P < 0.001和P = 0.002]。根据多变量Cox回归模型，发现hs-CRP/HDL-C比值是长期全因死亡率[风险比（HR）= 1.09，95%置信区间（CI）：1.05 - 1.13]和心血管死亡率（HR = 1.11，95% CI：1.05 - 1.19）的独立危险因素。两段式线性回归模型表明，当hs-CRP/HDL-C比值小于1.21时，全因死亡率风险增加更为显著。此外，发现与吸烟状况存在显著的交互作用（P = 0.006），表明hs-CRP/HDL-C比值与全因死亡率之间的关联在非吸烟者中更强。RCS曲线显示，在调整潜在混杂因素后，hs-CRP/HDL-C比值与长期死亡率呈正线性关联。
结论
hs-CRP/HDL-C比值是普通人群长期死亡率至关重要的预测指标，独立于潜在混杂因素。
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