血浆氧化三甲胺水平对冠心病患者预后的预测作用:剂量-反应Meta分析

Prognostic Value of Plasma Trimethylamine-N-oxide Levels for Patients With Coronary Heart Disease:a Meta-analysis and Dose-responses Analysis

目的:探讨冠心病患者的血浆氧化三甲胺(TMAO)水平与主要不良心血管事件(MACE)以及全因死亡风险之间的关系。方法:计算机检索2020年7月前发表并收录在PubMed、EMBASE、中国知网、万方等数据库中评估冠心病患者血浆TMAO水平与MACE(心血管死亡、心肌梗死、脑卒中、血管重建、再入院)及全因死亡风险相关性的队列研究,通过Meta分析和剂量-反应关系分析评估冠心病患者中血浆TMAO水平与MACE及全因死亡风险之间的关系。结果:最终共纳入10篇文献,包含12项队列研究(n=13332,包括2420例MACE和1118例全因死亡)。Meta分析结果显示,与血浆TMAO水平较低者相比,血浆TMAO水平较高的冠心病患者中MACE发生风险增加63%(HR=1.63,95%CI:1.39~1.90,P<0.001),全因死亡风险增加51%(HR=1.51,95%CI:1.30~1.74,P<0.001)。剂量-反应关系分析显示,血浆TMAO水平与MACE发生风险呈线性相关,血浆TMAO水平每升高1μmol/L,MACE相对发生风险增加10.2%。结论:在冠心病患者中,血浆TMAO水平升高增加MACE和全因死亡风险。

Objectives:To investigate the relationship between plasma trimethylamine N-oxide(TMAO)levels and major adverse cardiovascular events(MACE)or all-cause mortality risk in patients with coronary heart disease.Methods:Meta-analysis and dose-response analysis were performed to define the hazard ratio(HR)between plasma TMAO levels and the risk of MACE or all-cause mortality in patients with coronary heart disease.Results:PubMed,EMBASE,CNKI,Wanfang Databases were searched for studies published up to June 2017,10 articles including 12 cohort studies were finally included(n=13332,including 2420 MACE and 1118 all-cause death events).The results showed that the elevated plasma TMAO levels were associated with 63% higher risk of MACE(HR=1.63,95%CI:1.39-1.90,P<0.001)and 51%higher risk of all-cause death(HR=1.51,95%CI:1.30-1.74,P<0.001)in patients with coronary heart disease.Dose-response analysis showed a linear correlation between plasma TMAO levels and MACE risk.The HR for MACE increased by 10.2% per each 1μmol/L increment of plasma TMAO level.Conclusions:Elevated plasma TMAO levels is associated with increased risk of MACE and all-cause mortality in patients with coronary heart disease.The HR for MACE increases by 10.2% per each 1μmol/L increment of plasma TMAO level.