發(fā)布時(shí)間：2018-03-17 22:00

  本文選題：C反應(yīng)蛋白　切入點(diǎn)：種族差異　出處：《第二軍醫(yī)大學(xué)》2009年博士論文　論文類型：學(xué)位論文

【摘要】： 研究背景:美國(guó)疾病控制與預(yù)防中心和美國(guó)心臟協(xié)會(huì)(CDC/AHA)建議根據(jù)C反應(yīng)蛋白(CRP)水平對(duì)患者進(jìn)行心血管病危險(xiǎn)性分類:1.0mg/L為相對(duì)低危險(xiǎn),1.0-3.0mg/L為中度危險(xiǎn),3.0mg/L為高度危險(xiǎn)。然而該CRP界值是根據(jù)幾乎都來(lái)自歐洲或歐美的白種人確定的,其在我國(guó)人群的適用性尚不清楚。多種族研究表明心血管疾病的發(fā)病率和病死率存在種族差異,這種差異可能與CRP水平的種族差異有關(guān),但是目前關(guān)于白種人和亞洲人的CRP差異尚存在矛盾的報(bào)導(dǎo)。有研究報(bào)導(dǎo)白種人中CRP高于亞洲人,也有人認(rèn)為二者的水平無(wú)差別或者亞洲人的CRP水平更高。 有學(xué)者建議檢測(cè)CRP篩查心血管高危人群,但是在將CRP用于臨床評(píng)價(jià)心血管危險(xiǎn)性,篩選高危人群之前,了解一般人群的CRP分布范圍、特征及其與傳統(tǒng)心血管危險(xiǎn)因素的關(guān)系很重要。有學(xué)者進(jìn)行了CRP在我國(guó)人群中分布的研究,但是研究人群樣本量較小或者調(diào)查對(duì)象缺乏代表性,所以我國(guó)尚缺乏有代表性的成年人CRP分布的資料,而且CRP與傳統(tǒng)心血管危險(xiǎn)因素的關(guān)系也需要進(jìn)一步研究。 CDC/AHA提出應(yīng)該調(diào)查CRP在不同人群中的分布,探討適合各個(gè)人群特點(diǎn)的CRP界值,然而未見(jiàn)我國(guó)以及其它東亞國(guó)家關(guān)于CRP評(píng)價(jià)一般人群心血管危險(xiǎn)界值的研究。 研究目的:系統(tǒng)評(píng)價(jià)以往關(guān)于白種人和亞洲人中CRP水平的文獻(xiàn),了解CRP在白種人和亞洲人的不同,判斷CRP評(píng)價(jià)心血管危險(xiǎn)的界值是否適用于我國(guó)人群。并通過(guò)流行病學(xué)方法,在上海成年人中調(diào)查CRP的基線水平、分布特征及其與傳統(tǒng)心血管疾病危險(xiǎn)因素的關(guān)系,研究適用于我國(guó)人群的用于心血管疾病一級(jí)預(yù)防的CRP界值。 研究方法:計(jì)算機(jī)檢索2008年12月以前Pubmed、Embase等數(shù)據(jù)庫(kù)并配合手工查找關(guān)于白種人和亞洲人中CRP水平的文獻(xiàn),由兩位評(píng)價(jià)員分別對(duì)篩選的文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià),納入符合條件的研究,對(duì)白種人和亞洲人間CRP差異進(jìn)行Meta分析。另外,在上海18-80歲表面健康人群中進(jìn)行橫斷面調(diào)查,應(yīng)用隨機(jī)、多階段、分層抽樣的方法獲得有代表性的樣本。問(wèn)卷調(diào)查結(jié)合實(shí)驗(yàn)室檢查,調(diào)查CRP在人群中的分布、特點(diǎn)及其與傳統(tǒng)心血管危險(xiǎn)因素的關(guān)系。利用受試者工作特征(ROC)曲線分析法,計(jì)算每個(gè)給定的CRP值對(duì)應(yīng)的靈敏度、特異度和ROC曲線中的距離,尋找發(fā)現(xiàn)多種心血管危險(xiǎn)因素的最佳CRP界值。 結(jié)果:最終有9篇文獻(xiàn)納入系統(tǒng)評(píng)價(jià),其中各有4篇關(guān)于白種人和東亞人、白種人和南亞人CRP水平的研究,有1篇既納入了東亞人又納入了南亞人。通過(guò)Meta分析發(fā)現(xiàn)白種人與亞洲人(包括東亞人和南亞人)間CRP無(wú)差別,合并加權(quán)均數(shù)差值(WMD)為0.25mg/L [95%CI (-0.09,0.59),P0.00001],但是研究間存在明顯的異質(zhì)性(P0.00001, I2=93.7%)。按南亞人和東亞人分組分析發(fā)現(xiàn),白種人和東亞人之間WMD為0.84 mg/L[95% CI(0.76,0.91),P0.00001],白種人和南亞人之間WMD為-0.29 mg/L[95% CI (-0.44,-0.13),P=0.0003],而且亞組分析中研究間無(wú)異質(zhì)性。 共3153人參加調(diào)查,應(yīng)答率為87.58%。最終3133人(男性1393人,女性1740人)進(jìn)入統(tǒng)計(jì)分析。我國(guó)人群的CRP中位數(shù)為0.58 mg/L (男性0.64 mg/L,女性0.53mg/L),男性高于女性,城市高于農(nóng)村,CRP水平隨年齡的增高而增高。60%以上的調(diào)查對(duì)象CRP水平低于1.0 mg/L。未發(fā)現(xiàn)CRP與吸煙、飲酒及體育鍛煉有關(guān),體重指數(shù)、腰圍、總膽固醇、低密度脂蛋白膽固醇、甘油三酯及空腹血糖均隨著CRP的升高而升高,高密度脂蛋白膽固醇隨著CRP的升高降低�？刂破渌幸蛩睾�,超重、高密度脂蛋白降低、低密度脂蛋白升高、高甘油三酯、高血糖和高血壓與CRP增高有關(guān)。超重、血脂異常(高密度脂蛋白降低、低密度脂蛋白升高、高甘油三酯)、高血糖和高血壓者中50%以上CRP低于1.0mg/L,即使CRP在“正�！狈秶鷥�(nèi)的升高,危險(xiǎn)因素的患病率也隨之增加。傳統(tǒng)心血管危險(xiǎn)因素多呈聚集現(xiàn)象,患病率隨CRP的增加而增加主要是由三個(gè)以上上述危險(xiǎn)因素的增加引起的。CRP不同截點(diǎn)發(fā)現(xiàn)三個(gè)或三個(gè)以上危險(xiǎn)因素的靈敏度和特異度及ROC曲線的距離表明男女CRP評(píng)價(jià)心血管危險(xiǎn)的最佳界值為0.7 mg/L。 結(jié)論:中國(guó)人的CRP水平與白種人不同,低于白種人,目前的CRP評(píng)價(jià)心血管危險(xiǎn)的界值不適用于我國(guó)人群。CRP與多種心血管危險(xiǎn)因素有關(guān),評(píng)價(jià)我國(guó)心血管高危人群需要比目前所用界值更低的CRP界值,建議0.7 mg/L為較為合適的評(píng)價(jià)我國(guó)人群心血管危險(xiǎn)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┒鏂規(guī)硶:璁＄畻鏈烘绱，

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