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目的探讨累积平均动脉压(cumMAP)对全因死亡的预测价值。方法选择参加2006-2007、2008-2009及2010-2011年度健康体检且资料完整的开滦集团在职及离退休职工56 039人作为观察对象,进行了平均4.92年的随访,每年通过开滦社会保障信息系统获取死亡信息。cumMAP计算公式为[(MAP_1+MAP_2)/2×time_(1-2)]+[(MAP_2+MAP_3)/2×time_(2-3)],其中MAP_1、MAP_2、MAP_3分别为根据第1、2、3次体检血压值计算的平均动脉血压,time1-2、time2-3为相邻两次体检血压测量的时间间隔。将研究对象按cumMAP四分位分成4组,比较各组全因死亡率的差异,并采用多因素Cox比例风险模型分析cumMAP与全因死亡的关系。结果在平均4.92年随访期内共有1805例(3.2%)发生全因死亡。cumMAP第1~4四分位组全因死亡率分别为1.1%、2.3%、3.8%、5.6%(P<0.01)。多因素Cox回归分析结果显示,在校正包括基线收缩压、平均动脉压在内的多种混杂因素后,与第1四分位组相比,第2、3、4四分位组发生全因死亡的HR值(95%CI)分别为1.17(0.95~1.43)、1.32(1.08~1.61)和1.34(1.09~1.65)。结论 cumMAP是全因死亡的独立危险因素。
Objective To investigate the predictive value of cumulative mean arterial pressure (cumMAP) for all-cause mortality. Methods A total of 56 039 working and retired employees of Kailuan Group, who participated in health examination in 2006-2007, 2008-2009 and 2010-2011, were selected as the observation subjects and followed for an average of 4.92 years. Each year, Kailuan Social Security Information system to obtain death information. cumMAP is calculated as [(MAP_1 + MAP_2) / 2 × time_ (1-2)] + [(MAP_2 + MAP_3) / 2 × time_ (2-3)], where MAP_1, MAP_2, The average arterial blood pressure was calculated on the second and third physical examination blood pressure values. Time1-2 and time2-3 were the blood pressure measurement intervals between two consecutive physical examinations. The subjects were divided into four groups according to cumMAP quartiles, and the differences of all-cause mortality were compared. The relationship between cumMAP and all-cause mortality was analyzed by multivariate Cox proportional hazards model. Results A total of 1805 (3.2%) all-cause deaths occurred during an average of 4.92 years of follow-up. The all-cause mortality rates for the first to fourth quartiles of cumMAP were 1.1%, 2.3%, 3.8%, and 5.6%, respectively (P <0.01). Multivariate Cox regression analysis showed that after adjusting for various confounding factors including baseline systolic pressure and mean arterial pressure, all-cause The HR of death (95% CI) was 1.17 (0.95-1.43), 1.32 (1.08-1.61) and 1.34 (1.09-1.65), respectively. Conclusion cumMAP is an independent risk factor for all-cause mortality.