氧化三甲胺与心脑血管疾病发生风险的关系:一项Meta分析

Relationship between trimethylamine N-oxide and risk of cardio-cerebrovascular disease: a Meta-analysis

目的系统评价氧化三甲胺(TMAO)与心脑血管疾病不良预后之间的关系。方法检索PubMed及Embase数据库的英文文献,筛选出从建库至2019年2月发表的关于TMAO与心脑血管疾病相关性的前瞻性队列研究文献。根据参试者基线血浆TMAO水平的不同,各队列中参试者均分为TMAO高浓度组和低浓度组。结局指标包括2个,分别为高浓度组与低浓度组发生不良临床结局(ACO)的风险比(HR)及主要心脑血管不良事件(MACCE)的HR,按照参试者的年龄、国籍、疾病构成,研究的随访时间及文献发表年份等因素的不同分别进行亚组分析,采用Meta分析汇总HR。结果共纳入18篇文献,与TMAO低浓度组相比,TMAO高浓度组发生ACO的风险高64%[HR=1.64,95%CI(1.37~1.96)],发生MACCE的风险高52%[HR=1.52,95%CI(1.25~1.85)]。结论血浆TMAO水平与ACO、MACCE等临床结局事件的发生率呈正相关。

Objective To systematically review the relationship between trimethylamine N-oxide(TMAO)and the poor prognosis of cardio-cerebrovascular disease.Methods English literatures from the PubMed database and the Embase database were comprehensively retrieved,and prospective cohort study literatures regarding relationship between TMAO and cardio-cerebrovascular disease published from the establishment of databases to February 2019 were selected.According to the baseline plasma TMAO level,the participants in each cohort were divided into the TMAO high concentration group and the TMAO low concentration group.There were two outcome measures:the hazard ratio(HR)of ACO(adverse clinical outcomes)and MACCE(major cardiovascular and cerebrovascular adverse events)which were the high-concentration TMAO group versus the low-concentration group.The subgroup analysis was performed according to the age,nationality,disease constitution of participants,studies'follow-up time and publication years.The Meta-analysis was used to summary the HRs.Results A total of eighteen literatures were selected for this analysis.Compared with the TMAO low concentration group,the TMAO high concentration group had a 64%higher risk of ACO[HR=1.64,95%CI(1.37-1.96)],and a 52%higher risk of MACCE[HR=1.52,95%CI(1.25-1.85)].Conclusion The plasma TMAO level was positively correlated with the incidence of clinical outcomes such as ACO and MACCE.