Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses
Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses
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DOI：
10.1136/bmj.321.7255.199
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发表时间：
2000-07-22
影响因子：
105.7
通讯作者：
Pepys, MB
中科院分区：
文献类型：
--
作者：
Danesh, J;Whincup, P;Pepys, MB
目的评估四种不同的炎症循环标志物的基线值与冠心病的未来风险、全身炎症的潜在触发因素之间的关系（如持续感染），和其他炎症标志物。设计前瞻性，以人群为基础的队列研究。背景：英国18个城镇的一般医疗实践。参与者506名死于冠心病或非冠心病的男性，从1978 - 1980年提供血液样本的5661名40 - 59岁男性中选择1025名直到1996年仍无此类疾病的男性。主要结果测量血浆C反应蛋白，血清淀粉样蛋白A蛋白，以及血清白蛋白和白细胞计数致命性和非致命性冠心病的信息从医疗记录和死亡证明中获得。结果与C反应蛋白基线测量值最低三分之一的男性相比，在调整了年龄、城镇、吸烟、血管危险因素和社会经济地位指标后，前三分之一的男性患冠心病的优势比为2.13（95%置信区间为1.38至3.28）。血清淀粉样蛋白A蛋白、白细胞计数和白蛋白的校正比值比相似，分别为1.65（1.07 - 2.55）、1.12（0.71 - 1.77）和0.67（0.43 - 1.04）。没有观察到这些因素与幽门螺杆菌血清阳性、肺炎衣原体IgG滴度或血浆总同型半胱氨酸浓度有很强的相关性。急性期反应物的基线值彼此显著相关（P <0.0001），虽然低血清白蛋白浓度与白细胞计数的相关性较弱结论结合其他相关研究结果，这些发现提示某些与慢性感染无关的炎症过程，很可能与冠心病有关。
Objective To assess associations between baseline values of four different circulating markers of inflammation and future risk of coronary heart disease, potential triggers of systemic inflammation (such as persistent infection), and other markers of inflammation.Design Nested case-control comparisons in a prospective, population based cohort.Setting General practices in 18 towns in Britain.Participants 506 men who died from coronary heart disease or had a non-fatal myocardial infarction and 1025 men who remained free of such disease until 1996 selected from 5661 men aged 40-59 years who provided blood samples in 1978-1980.Main outcome measures Plasma concentrations of C reactive protein, serum amyloid A protein, and serum albumin and leucocyte count Information on fatal and non-fatal coronary heart disease was obtained from medical records and death certificates.Results Compared with men in the bottom third of baseline measurements of C reactive protein, men in the top third had an odds ratio for coronary heart disease of 2.13 (95% confidence interval 1.38 to 3.28) after age, town, smoking, vascular risk factors, and indicators of socioeconomic status were adjusted for. Similar adjusted odds ratios were 1.65 (1.07 to 2.55) for serum amyloid A protein; 1.12 (0.71 to 1.77) for leucocyte count; and 0.67 (0.43 to 1.04) for albumin. No strong associations were observed of these factors with Helicobacter pylori seropositivity, Chlamydia pneumoniae IgG titres, or plasma total homocysteine concentrations. Baseline values of the acute phase reactants were significantly associated with one another (P < 0.0001), although the association between low serum albumin concentration and leucocyte count was weaker (P = 0.08).Conclusion In the context of results from other relevant studies these findings suggest that some inflammatory processes, unrelated to the chronic infections studied here, are likely to be involved in coronary heart disease.