炎症因子对全因死亡的预测价值研究：开滦集团8.3万职工6.9年随访结果

摘要

Objective: To explore the predictive value of inlfammatory factors on all cause mortality in normal population. Methods: In our prospective cohort study, a total of 83,228 subjects from physical examination of Kailuan group from 2006-07 to 2007-10 were enrolled, nobody had acute inlfammation. The death information was collected once per year and the last follow-up was conducted in 2013-12-31. According to baseline levels, white blood cells (WBC), ratio of neutrophil/lymphocyte ratio (N/L) and C-reactive protein (CRP) were respectively divided into 4 Quartile groups; all cause mortality was compared among different groups and their risks were studied by multi-Cox regression analysis. Results: The average follow-up time was 6.9 years. All cause mortality in Quartile 1, Quartile 2, Quartile 3 and Quartile 4 groups for WBC were 4.2%, 4.5%, 4.5% and 5.0% respectively; for N/L were 3.3%, 3.6%, 4.5% and 6.7% respectively; for CRP were 3.0%, 3.6%, 4.8% and 6.8% respectively. Multi-Cox regression analysis indicated that with adjusted age, gender, waist and other confounders, by elevation of WBC, N/R and CRP, the risks of all cause mortality were increased accordingly, and the risks in Quartile 4 groups were higher than those in Quartile 1 groups as for WBC, it was 1.17-time (95% CI 1.06-1.29);for N/L, it was 1.44-time (95% CI 1.31-1.59); for CRP, it was 1.33-time (95% CI 1.20-1.47) respectively. Conclusion: Elevated WBC, N/R and CRP are independent risk factors for all cause mortality in normal population.%目的：探讨炎症因子水平对全因死亡的预测价值。　　方法：采用前瞻性队列研究，以参加2006-07至2007-10开滦集团公司健康体检的在职及离、退休职工为研究对象，排除急性炎症及资料不全者，最终83228名受试者纳入研究队列，每年收集1次员工死亡信息，末次随访时间为2013-12-31。将研究对象分别按基线白细胞计数（WBC）、中性粒细胞与淋巴细胞比率（NLR）、C反应蛋白（CRP）的四分位数分组，比较各组全因死亡率，并采用多因素Cox回归模型分析各组全因死亡的发生风险。　　结果：平均随访6.9年后，基线WBC第一、二、三、四四分位组的全因死亡率分别为4.2%、4.5%、4.5%和5.0%（P<0.001）；基线NLR第一、二、三、四四分位组的全因死亡率分别为3.3%、3.6%、4.5%和6.7%（P<0.001）；基线CRP第一、二、三、四四分位组的全因死亡率分别为3.0%、3.6%、4.8%和6.8%（P<0.001）。多因素Cox回归分析结果显示，校正年龄、性别、腰围等混杂因素后，随着基线WBC、NLR和CRP水平升高，全因死亡的发生风险均呈递增趋势，且基线WBC、NLR、CRP第四四分位组发生全因死亡的风险分别为第一四分位组的1.17[95%可信区间（CI）：1.06~1.29]、1.44（95% CI：1.31~1.59）、1.33（95% CI：1.20~1.47）倍。　　结论：WBC、NLR和CRP水平均为全因死亡的独立预测因子。