CRP和白蛋白能预测老年人血管性和非血管性死亡率

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Biomarkers of inflammation predict both vascular and non-vascular mortality in older men
炎症指标对老年男性血管和非血管死亡的预测
Aims: To compare the predictive value of inflammatory biomarkers and lipids for vascular and non-vascular mortality in older men.
目的：比较炎症指标和血脂对老年男性血管和非血管死亡的预测。
Methods and results: The relevance of inflammatory biomarkers and lipids for vascular and non-vascular mortality was assessed in a prospective study of 5360 men (mean age 77 years) followed for 7 years. Vascular mortality was positively associated with log C-reactive protein (lnCRP), fibrinogen and total/HDL-C (high-density lipoprotein cholesterol), and inversely associated with albumin [age adjusted hazard ratio (HR) per 2-SD higher usual level (approximately the difference between the top and the bottom thirds of the distribution): 2.09 for lnCRP; 1.70 for fibrinogen; 0.50 for albumin and 1.45 for total/HDL-C]. The associations with the inflammatory markers were attenuated after adjustment for established risk factors, including lipids [adjusted HRs: 1.86 (lnCRP); 1.44 (fibrinogen); 0.51 (albumin)], and further attenuated (and, for fibrinogen, no longer predictive) after adjustment for each other [fully adjusted HRs: 1.60 (lnCRP); 1.01 (fibrinogen); 0.61 (albumin)]. Higher CRP and lower albumin levels were also associated with significantly raised non-vascular mortality independently of other characteristics [fully adjusted HRs: 1.62 (lnCRP); 0.65 (albumin)].
方法和结果——通过一项纳入5360男性（平均年龄77岁），随访7年的前瞻性研究中，评价炎症指标和血脂与血管和非血管死亡的关系。血管性死亡与C反应蛋白的自然对数（InCRP）、纤维蛋白原和总胆固醇/高密度脂蛋白胆固醇呈正相关，与白蛋白呈负相关【校正年龄后每增加2个标准差（大约是最高和最低三分位区间的差值）的危险比：InCRP 2.09，纤维蛋白原1.70，白蛋白 0.50，total/HDL-C 1.45】。校正了包括血脂在内的一直危险因素后，与炎症指标的关系有所减弱（校正后危险比：lnCRP 1.86，纤维蛋白原 1.44，白蛋白 0.51），互相校正后关系进一步减弱（纤维蛋白原不再有预测价值）（完全校正后的危险比：lnCRP 1.60，纤维蛋白原1.01，白蛋白0.61）。高C反应蛋白水平和地白蛋白水平还与非血管死亡增加有关并独立于其它指标之外（完全校正后危险比： lnCRP 1.62，白蛋白0.65）。
Conclusion: In this cohort of older men, higher CRP and lower albumin levels strongly predicted both vascular and non-vascular mortality, independently of other characteristics.
结论：在这一老年男性队列中，高C反应蛋白水平和低白蛋白水平是血管和 非血管死亡的强预测因子，并独立于其它因素。