血浆甲氧基肾上腺素类物质对高危高血压患者心脑血管事件的预测价值

Role of plasma metanephrines in predicting cardiovascular and cerebrovascular events in hypertensive patients with high cardiovascular risk

目的探讨血浆甲氧基肾上腺素类物质(MNs),包括甲氧基肾上腺素(MN)和甲氧基去甲肾上腺素(NMN),对高危高血压患者心脑血管事件的预测价值。方法回顾性分析2016年10月-2018年8月就诊于北京安贞医院诊断为原发性高血压的住院患者688例,随访时间中位数(P_(25)~P_(75))为24(20~29)个月,主要终点定义为:全因死亡和/或因心脑血管原因再入院。根据患者是否出现主要终点事件分为事件组(n=57)和无事件组(n=631)。采用高效液相色谱串联质谱方法测定MNs水平,利用受试者工作特征(ROC)曲线分析得到血浆NMN预测终点事件的截断值为125.75ng/L。根据血浆NMN的截断值将患者分为两组(NMN≤125.75ng/L组和NMN>125.75ng/L组)。Kaplan-Meier生存曲线和多因素Cox回归分析用于评估NMN是否为高危高血压患者发生心脑血管事件的危险因素。结果事件组的血浆NMN水平高于无事件组[110.0(74.0~135.0)比88.5(62.0~119.5)ng/L,Z=-2.862,P=0.004];血浆NMN≤125.75ng/L组和NMN>125.75ng/L组主要终点事件率分别是6.0%、15.8%;Kaplan-Meier曲线显示,NMN水平越高,发生心脑血管事件的发生率越高(Log-rankχ^(2)=16.714,P<0.001);Cox回归分析显示,经多因素校正以后,NMN>125.75ng/L组患者发生主要终点事件的风险是NMN≤125.75ng/L组的2.11倍(HR=2.11,95%CI1.15~3.84,P=0.015)。结论当血浆NMN处于高水平时,高危高血压患者的心脑血管事件风险更高。

Objective To investigate the role of plasma metanephrines(MNs),including metanephrines(MN)and normetanephrines(NMN),in predicting cardiovascular events in essential hypertensive patients.Methods In a retrospective analysis of 688hospitalized patients diagnosed with essential hypertension at the Beijing Anzhen hospital from October 2016to August 2018,with a median(interquartile range)follow-up time of 24(20-29)months.The primary endpoint was defined as all-cause death and/or readmission for cardiovascular or cerebrovascular.Patients were divided into event group(n=57)and no-event group(n=631).High performance liquid chromatography tandem mass spectrometry was used to determine MN levels.Patients were divided into two groups according to the cut-off value of plasma NMN from receiver operating characteristic(ROC)analysis,namely NMN≤125.75ng/L group and NMN>125.75ng/L group.The effects of NMN on the prognosis of hypertensive patients were evaluated by Kaplan-Meier plots and multivariate Cox regression analysis.Results The plasma NMN level of the event group was higher than that of the no-event group[(110.0(74.0-135.0)vs 88.5(62.0-119.5)ng/L,Z=-2.862,P=0.004].The incidence of the primary endpoint event in NMN≤125.75ng/L group and NMN>125.75ng/L group was 6.0%and 15.8%,respectively.A Kaplan-Meier curve showed patients with higher baseline NMN levels were more likely to experience adverse events(Log-rankχ^(2)=16.714,P<0.001).Cox regression analysis showed that patients in NMN>125.75ng/L group had 2.11fold higher risk of the primary endpoint event than those in NMN≤125.75ng/L group(HR=2.11,95%CI 1.15-3.84,P=0.015).Conclusion High risk hypertensive patients are at higher risk of cardiovascular and cerebrovascular events when plasma NMN is at high levels.