C反应蛋白种族差异的Meta分析及其与心血管危险因素关系的流行病学研究
发布时间：2018-03-17 22:00
本文选题：C反应蛋白 切入点：种族差异 出处：《第二军医大学》2009年博士论文 论文类型：学位论文
【摘要】： 研究背景:美国疾病控制与预防中心和美国心脏协会(CDC/AHA)建议根据C反应蛋白(CRP)水平对患者进行心血管病危险性分类:1.0mg/L为相对低危险,1.0-3.0mg/L为中度危险,3.0mg/L为高度危险。然而该CRP界值是根据几乎都来自欧洲或欧美的白种人确定的,其在我国人群的适用性尚不清楚。多种族研究表明心血管疾病的发病率和病死率存在种族差异,这种差异可能与CRP水平的种族差异有关,但是目前关于白种人和亚洲人的CRP差异尚存在矛盾的报导。有研究报导白种人中CRP高于亚洲人,也有人认为二者的水平无差别或者亚洲人的CRP水平更高。 有学者建议检测CRP筛查心血管高危人群,但是在将CRP用于临床评价心血管危险性,筛选高危人群之前,了解一般人群的CRP分布范围、特征及其与传统心血管危险因素的关系很重要。有学者进行了CRP在我国人群中分布的研究,但是研究人群样本量较小或者调查对象缺乏代表性,所以我国尚缺乏有代表性的成年人CRP分布的资料,而且CRP与传统心血管危险因素的关系也需要进一步研究。 CDC/AHA提出应该调查CRP在不同人群中的分布,探讨适合各个人群特点的CRP界值,然而未见我国以及其它东亚国家关于CRP评价一般人群心血管危险界值的研究。 研究目的:系统评价以往关于白种人和亚洲人中CRP水平的文献,了解CRP在白种人和亚洲人的不同,判断CRP评价心血管危险的界值是否适用于我国人群。并通过流行病学方法,在上海成年人中调查CRP的基线水平、分布特征及其与传统心血管疾病危险因素的关系,研究适用于我国人群的用于心血管疾病一级预防的CRP界值。 研究方法:计算机检索2008年12月以前Pubmed、Embase等数据库并配合手工查找关于白种人和亚洲人中CRP水平的文献,由两位评价员分别对筛选的文献进行质量评价,纳入符合条件的研究,对白种人和亚洲人间CRP差异进行Meta分析。另外,在上海18-80岁表面健康人群中进行横断面调查,应用随机、多阶段、分层抽样的方法获得有代表性的样本。问卷调查结合实验室检查,调查CRP在人群中的分布、特点及其与传统心血管危险因素的关系。利用受试者工作特征(ROC)曲线分析法,计算每个给定的CRP值对应的灵敏度、特异度和ROC曲线中的距离,寻找发现多种心血管危险因素的最佳CRP界值。 结果:最终有9篇文献纳入系统评价,其中各有4篇关于白种人和东亚人、白种人和南亚人CRP水平的研究,有1篇既纳入了东亚人又纳入了南亚人。通过Meta分析发现白种人与亚洲人(包括东亚人和南亚人)间CRP无差别,合并加权均数差值(WMD)为0.25mg/L [95%CI (-0.09,0.59),P0.00001],但是研究间存在明显的异质性(P0.00001, I2=93.7%)。按南亚人和东亚人分组分析发现,白种人和东亚人之间WMD为0.84 mg/L[95% CI(0.76,0.91),P0.00001],白种人和南亚人之间WMD为-0.29 mg/L[95% CI (-0.44,-0.13),P=0.0003],而且亚组分析中研究间无异质性。 共3153人参加调查,应答率为87.58%。最终3133人(男性1393人,女性1740人)进入统计分析。我国人群的CRP中位数为0.58 mg/L (男性0.64 mg/L,女性0.53mg/L),男性高于女性,城市高于农村,CRP水平随年龄的增高而增高。60%以上的调查对象CRP水平低于1.0 mg/L。未发现CRP与吸烟、饮酒及体育锻炼有关,体重指数、腰围、总胆固醇、低密度脂蛋白胆固醇、甘油三酯及空腹血糖均随着CRP的升高而升高,高密度脂蛋白胆固醇随着CRP的升高降低。控制其他所有因素后,超重、高密度脂蛋白降低、低密度脂蛋白升高、高甘油三酯、高血糖和高血压与CRP增高有关。超重、血脂异常(高密度脂蛋白降低、低密度脂蛋白升高、高甘油三酯)、高血糖和高血压者中50%以上CRP低于1.0mg/L,即使CRP在“正常”范围内的升高,危险因素的患病率也随之增加。传统心血管危险因素多呈聚集现象,患病率随CRP的增加而增加主要是由三个以上上述危险因素的增加引起的。CRP不同截点发现三个或三个以上危险因素的灵敏度和特异度及ROC曲线的距离表明男女CRP评价心血管危险的最佳界值为0.7 mg/L。 结论:中国人的CRP水平与白种人不同,低于白种人,目前的CRP评价心血管危险的界值不适用于我国人群。CRP与多种心血管危险因素有关,评价我国心血管高危人群需要比目前所用界值更低的CRP界值,建议0.7 mg/L为较为合适的评价我国人群心血管危险的界值。
[Abstract]:Background: the Centers for Disease Control and prevention and the American Heart Association (CDC/AHA) according to the recommendations of C reactive protein (CRP) level of cardiovascular risk in patients with 1.0mg/L is relatively low risk, moderate risk for 1.0-3.0mg/L, 3.0mg/L is highly dangerous. But the CRP value is based on almost all from Europe or Europe white people identified, its applicability in our country population is not clear. Many studies show that there is a family of racial differences in the incidence rate and mortality rate of cardiovascular disease, the racial differences in this difference may be related to the level of CRP, but the CRP difference on Caucasians and Asians there are conflicting reports. It was reported that white people in CRP is higher than that of Asians, some people think that no differences between the two levels of CRP or Asian higher level.
Some scholars suggest that the detection of CRP screening for cardiovascular risk groups, but in CRP for clinical evaluation of cardiovascular risk, before the screening of high-risk population, understand the distribution of CRP in the general population, the relationship between the characteristics and factors and traditional cardiovascular risk is very important. Some scholars have studied the distribution of CRP in the Chinese population, but the study sample a smaller crowd or the subjects lack of representation, so our country still lacks the representative of the adult CRP distribution, and the relationship between CRP and traditional cardiovascular risk factors also need further research.
CDC/AHA suggested that we should investigate the distribution of CRP in different populations and explore the CRP boundary values suitable for each group. However, no research on CRP evaluation of general population's cardiovascular risk boundary in China or other East Asian countries has been made.
Objective: To review the evidence for CRP levels in whites and Asians literature, understand CRP in Caucasians and Asians have different judgments, CRP to evaluate cardiovascular risk threshold is applicable to the population in our country. And through the investigation of epidemiology, baseline levels of CRP in Shanghai adults, the relationship between distribution and traditional risk study on the factors of cardiovascular disease, applicable to the population in our country for the primary prevention of cardiovascular disease CRP value.
鐮旂┒鏂规硶:璁＄畻鏈烘绱，
本文编号：1626649
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