C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease
C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease
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DOI：
10.1136/thx.2006.059808
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发表时间：
2006-10-01
期刊：
影响因子：
10
通讯作者：
Sin, D. D.
中科院分区：
文献类型：
--
作者：
Man, S. F. P.;Connett, J. E.;Sin, D. D.
背景资料：虽然C-反应蛋白（CRP）水平增加慢性阻塞性肺疾病（COPD），它是不确定的，他们是否与不良的临床outcomes.Methods：血清CRP水平测定4803参与者在肺健康研究与轻度至中度COPD。确定了全因和特定疾病死亡原因的风险以及心血管事件发生率，并根据年龄、性别、吸烟和肺功能等重要协变量进行了调整。心血管事件被定义为死于冠心病或中风，或非致命性心肌梗死或中风需要入院hospital.Results：CRP水平与全因，心血管和癌症的死亡率的具体原因。与CRP水平最低的五分位组相比，CRP水平最高的五分位组的全因死亡率的相对风险（RR）为1.79（95%置信区间（CI）为1.25 - 2.56）。对于心血管事件和癌症死亡，相应的RR分别为1.51（95% CI 1.20至1.90）和1.85（95% CI 1.10至3.13）。CRP水平也与1秒用力呼气量的加速下降相关（p < 0.001）。CRP的区分性在测量的第一年最大，并随着时间的推移而衰减。比较最高和最低CRP五分位数，RR为4.03（95% CI 1.23 - 13.21）1年死亡率，3.30 2年死亡率（95% CI 1.38 - 7.86）和1.82（95%CI 1.22 - 2.68）。结论：CRP测量提供了轻度至中度COPD患者传统预后标志物以外的增量预后信息，并且能够更准确地检测处于高死亡风险的患者。
Background: Although C-reactive protein (CRP) levels are increased in chronic obstructive pulmonary disease ( COPD), it is not certain whether they are associated with adverse clinical outcomes.Methods: Serum CRP levels were measured in 4803 participants in the Lung Health Study with mild to moderate COPD. The risk of all-cause and disease specific causes of mortality was determined as well as cardiovascular event rates, adjusting for important covariates such as age, sex, cigarette smoking, and lung function. Cardiovascular events were defined as death from coronary heart disease or stroke, or nonfatal myocardial infarction or stroke requiring admission to hospital.Results: CRP levels were associated with all-cause, cardiovascular, and cancer specific causes of mortality. Individuals in the highest quintile of CRP had a relative risk (RR) for all-cause mortality of 1.79 (95% confidence interval (CI) 1.25 to 2.56) compared with those in the lowest quintile of CRP. For cardiovascular events and cancer deaths the corresponding RRs were 1.51 ( 95% CI 1.20 to 1.90) and 1.85 ( 95% CI 1.10 to 3.13), respectively. CRP levels were also associated with an accelerated decline in forced expiratory volume in 1 second ( p < 0.001). The discriminative property of CRP was greatest during the first year of measurement and decayed over time. Comparing the highest and lowest CRP quintiles, the RR was 4.03 ( 95% CI 1.23 to 13.21) for 1 year mortality, 3.30 ( 95% CI 1.38 to 7.86) for 2 year mortality, and 1.82 ( 95% CI 1.22 to 2.68) for >= 5 year mortality.Conclusions: CRP measurements provide incremental prognostic information beyond that achieved by traditional markers of prognosis in patients with mild to moderate COPD, and may enable more accurate detection of patients at a high risk of mortality.