糖尿病人群中高敏C反应蛋白与新发心脑血管事件关系的前瞻性研究

目的 探讨基线血清高敏C反应蛋白(hsCRP)水平对糖尿病人群新发心脑血管事件的预测价值.方法 本研究采用前瞻性队列研究方法,以参加2006年7月至2007年10月健康查体的101 510名开滦集团职工中空腹血糖≥7.0 mmoL/L或＜7.0 mmol/L但已确诊为糖尿病,正在使用降糖药物的7865例糖尿病者作为观察队列,随访38～53(48.02±3.14)个月,随访期间每半年收集1次新发心脑血管事件情况.分析基线血清hsCRP水平对糖尿病人群新发心脑血管事件的预测价值.结果 (1)随着基线hsCRP水平的增高,发生总心脑血管事件、脑梗死和心肌梗死事件率均逐渐增高,差异有统计学意义(P＜0.01);多变量Cox比例风险回归分析表明校正年龄、性别、收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、体质指数及吸烟因素后,基线hsCRP最高四分位数组(hsCRP≥2.50 mg/L)发生总心脑血管事件、脑梗死和心肌梗死的相对危险(RR)分别为最低四分位数组(hsCRP＜0.41 mg/L)的1.64倍(95% CI:1.20～2.24,P=0.002),1.52倍(95% CI:1.03～2.24,P=0.034)和2.57倍(95% CI:1.34～4.91,P=0.004).(2)随着基线hsCRP水平的增高,研究对象的平均年龄逐渐增高;女性在人群中比例逐渐增多;体质指数、收缩压、舒张压、空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平增高,差异均有统计学意义(P＜0.05);高密度脂蛋白胆固醇水平降低,差异有统计学意义(P＜0.05).结论 基线hsCRP可预测糖尿病人群发生心脑血管事件,hsCRP水平较高者发生临床心脑血管事件的危险增加,尤其是脑梗死和心肌梗死的危险.

Abstract：

Objective To evaluate the predictive value of baseline serum high sensitivity C-reactive protein for the first cardio-cerebral vascular event in the population with diabetes. Method In this prospective cohort study, a total of 101 510 employees of Kai Luan Group, who received healthy examination from July 2006 to October 2007, were screened and 7865 subjects with fasting plasma glucose ≥ 7. 0 mmol/L or known diabetes mellitus and under insulin or hypoglycemic drugs therapy were followed up for 38 - 53 (48. 02 ± 3. 14) months. Results ( 1 ) Incidence rates of total cardio-cerebral vascular events, cerebral infarction and myocardial infarction increased in proportion to increased levels of baseline hsCRP ( P ＜ 0. 01 ). After adjusting for age, gender, body mass index ( BMI), systolic blood pressure( SBP), diastolic blood pressure (DBP), total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and cigarette smoking, multivariate Cox's proportional hazards regression analysis indicated that the individuals in the highest quartile of hsCRP levels group (hsCRP≥2. 50 mg/L) had an increased risk of total cardio-cerebral vascular events (RR: 1.64, 95% CI:1.20-2.24), cerebral infarction (RR: 1.52, 95% CI: 1.03-2.24), myocardial infarction (RR: 2.57,95% CI: 1.34 -4. 91 ) compared with those in the lowest quartile group( hsCRP ＜ 0. 41 mg/L). (2) Higher baseline hsCRP levels were associated with aging, female gender, higher BMI, SBP, DBP, fasting blood glucose, TC, TG, LDL-C levels and lower HDL-C levels ( all P ＜ 0. 05 ). Conclusion Baseline hsCRP level is associated with increased first cardio-cerebral vascular event in the population with diabetes.

Association between baseline high sensitivity C-reactive protein level and the first cardio-cerebral vascular event in diabetic population: a prospective cohort study

Objective To evaluate the predictive value of baseline serum high sensitivity C-reactive protein for the first cardio-cerebral vascular event in the population with diabetes. Method In this prospective cohort study, a total of 101 510 employees of Kai Luan Group, who received healthy examination from July 2006 to October 2007, were screened and 7865 subjects with fasting plasma glucose ≥ 7. 0 mmol/L or known diabetes mellitus and under insulin or hypoglycemic drugs therapy were followed up for 38 - 53 (48. 02 ± 3. 14) months. Results ( 1 ) Incidence rates of total cardio-cerebral vascular events, cerebral infarction and myocardial infarction increased in proportion to increased levels of baseline hsCRP ( P ＜ 0. 01 ). After adjusting for age, gender, body mass index ( BMI), systolic blood pressure( SBP), diastolic blood pressure (DBP), total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and cigarette smoking, multivariate Cox's proportional hazards regression analysis indicated that the individuals in the highest quartile of hsCRP levels group (hsCRP≥2. 50 mg/L) had an increased risk of total cardio-cerebral vascular events (RR: 1.64, 95% CI:1.20-2.24), cerebral infarction (RR: 1.52, 95% CI: 1.03-2.24), myocardial infarction (RR: 2.57,95% CI: 1.34 -4. 91 ) compared with those in the lowest quartile group( hsCRP ＜ 0. 41 mg/L). (2) Higher baseline hsCRP levels were associated with aging, female gender, higher BMI, SBP, DBP, fasting blood glucose, TC, TG, LDL-C levels and lower HDL-C levels ( all P ＜ 0. 05 ). Conclusion Baseline hsCRP level is associated with increased first cardio-cerebral vascular event in the population with diabetes.