Ke Juzhong, Liu Qingping, Liu Xiaolin, Wu Kang, Qiu Hua, Song Jiahui, Ruan Xiaonan, Zhou Yi
Shanghai Pudong New Area Center for Disease Control and Prevention (Shanghai Pudong New Area Health Supervision Institute), Shanghai, China.
Shanghai Pudong New Area Center for Disease Control and Prevention (Shanghai Pudong New Area Health Supervision Institute), Shanghai, China
BMJ Open. 2025 Aug 12;15(8):e101532. doi: 10.1136/bmjopen-2025-101532.
To investigate the role of C-reactive protein (CRP) in predicting all-cause and cause-specific mortality in a community-based Chinese cohort.
A community-based prospective cohort study.
34 communities in Pudong New Area, Shanghai, China.
A total of 9360 permanent residents from 34 randomly selected communities were enrolled in 2013. Follow-up began at baseline and continued until death or 30 September 2023, whichever occurred first.
The primary outcome of this study was death, as recorded in the Vital Registry of Pudong New Area, Shanghai, China. Associations between CRP and risks of all-cause and cause-specific mortality were studied. Cox proportional hazards models were applied to estimate HR and 95% CI. Adjustments were made for age, sex, area, marriage status, education, current smoking, alcohol consumption, physical activity, body mass index, systolic blood pressure, diastolic blood pressure, type 2 diabetes, dyslipidaemia and chronic kidney disease. Competing risk analyses were performed for cause-specific mortality. Restricted cubic splines were used to assess potential non-linear associations. We evaluated improvements in mortality prediction by calculating changes in the C-index, integrated discrimination improvement and net reclassification improvement after adding CRP to conventional risk factor models.
Over a median follow-up of 10.52 (IQR: 10.43-10.56) years, 920 deaths (9.68 per 1000 person-years) were recorded. After adjusting for traditional risk factors, higher baseline CRP levels were significantly associated with increased risk of all-cause mortality, cardiovascular mortality and cancer mortality. Non-linear associations were observed between CRP levels and all-cause and cancer mortality. The addition of CRP level significantly improved the reclassification and discrimination ability beyond the conventional risk factor models for all-cause mortality and cancer mortality.
Elevated CRP levels, indicative of low-grade inflammation, are an independent risk factor for all-cause, cardiovascular and cancer mortality.
探讨C反应蛋白（CRP）在预测中国社区队列全因死亡率和特定病因死亡率中的作用。
基于社区的前瞻性队列研究。
中国上海浦东新区的34个社区。
2013年，从34个随机选择的社区中招募了9360名常住居民。随访从基线开始，持续到死亡或2023年9月30日，以先发生者为准。
本研究的主要结局是死亡，在中国上海浦东新区生命登记处记录。研究了CRP与全因死亡率和特定病因死亡率风险之间的关联。应用Cox比例风险模型估计风险比（HR）和95%置信区间（CI）。对年龄、性别、地区、婚姻状况、教育程度、当前吸烟、饮酒、体力活动、体重指数、收缩压、舒张压、2型糖尿病、血脂异常和慢性肾脏病进行了调整。对特定病因死亡率进行了竞争风险分析。使用受限立方样条评估潜在的非线性关联。我们通过计算在传统风险因素模型中加入CRP后C指数的变化、综合判别改善和净重新分类改善来评估死亡率预测的改善情况。
在中位随访10.52（四分位间距：10.43 - 10.56）年期间，记录了920例死亡（每1000人年9.68例）。在调整传统风险因素后，较高的基线CRP水平与全因死亡率、心血管死亡率和癌症死亡率风险增加显著相关。在CRP水平与全因死亡率和癌症死亡率之间观察到非线性关联。CRP水平的加入显著提高了全因死亡率和癌症死亡率在传统风险因素模型之外的重新分类和判别能力。
CRP水平升高表明存在低度炎症，是全因、心血管和癌症死亡率的独立危险因素。
