摘要:
目的 采用大型前瞻性队列研究方法，探讨吸烟人群的高敏C-反应蛋白（high sensitivity C-reactive protein，hsCRP）和上消化道癌发病的相关性。方法 收集2006-2007年开滦集团职工体检数据和随访期内发生的上消化道癌数据，建立数据库。使用多因素Cox模型统计分析吸烟人群不同基线hsCRP水平与上消化道癌发病的关系。结果 队列最终纳入38 549人，中位随访时间8.1年，收集上消化道癌共123例。不同hsCRP水平组新发上消化道癌累积发病率（8年）分别为278/10万（hsCRP<1 mg/L组）、339/10万（1 ≤ hsCRP ≤ 3 mg/L组）和484/10万（hsCRP>3 mg/L组），Log-rank检验显示差异有统计学意义（（口恶）2=6.48，P=0.039）。多因素Cox模型分析显示，调整性别、年龄、是否饮酒、体质指数、既往糖尿病史、工作环境和教育程度因素后，hsCRP>3 mg/L组上消化道癌发病风险是hsCRP<1 mg/L组的1.64倍（95%CI：1.05~2.56，P=0.028）。在 ≥ 45岁人群中，hsCRP>3 mg/L组上消化道癌发病风险是hsCRP<1 mg/L组的1.71倍（95%CI：1.08~2.70，P=0.022）。结论 基线hsCRP水平升高可能增加上消化道癌发病风险。
Abstract:
Objective To investigate whether elevated level of high sensitivity C-reactive protein (hsCRP) at baseline is associated with an increased risk of upper gastrointestinal cancer among smokers in Kailuan cohort. Methods Levels of hsCRP were tested and demographic information and risk factor data were collected at baseline for all subjects (2006-2007). Multivariable Cox proportional hazards regression models were used to analyze the association between baseline levels of hsCRP and upper gastrointestinal cancer. Results A total of 38 549 smokers from the Chinese Kailuan cohort were enrolled in the study in July 2006. Median follow-up time was 8.1 years. A total of 123 new upper gastrointestinal cancer cases were diagnosed and were divided into three groups according to the level of hsCRP (<1 mg/L,1-3 mg/L and >3 mg/L). The eight years cumulative incidence of upper gastrointestinal cancer was 278/100 000, 339/100 000 and 484/100 000 in these 3 groups, respectively ((口恶)2=6.48,P=0.039). Compared to smokers with lower hsCRP levels (<1 mg/L), smokers with the highest hsCRP levels (>3 mg/L) had significantly increased risk of upper gastrointestinal cancer (HR=1.64, 95% CI:1.05-2.56, P=0.028) after adjusting for gender, age, drinking, BMI, diabetes, work environment and education degree. Compared to smokers with lower hsCRP levels (<1 mg/L), smokers with the highest hsCRP levels (>3 mg/L) had significantly increased risk of upper gastrointestinal cancer (HR=1.71, 95% CI:1.08-2.70, P=0.022) in the population of smokers aged 45 years old and above. Conclusions Elevated levels of hsCRP at baseline might increase the risk of upper gastrointestinal cancer in smokers.
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