肾上腺髓质素前体中段肽对心力衰竭患者预后预测价值的Meta分析

Predictive value of mid-regional pro-adrenomedullin to prognosis in patients with heart failure:a Meta-analysis

目的采用Meta分析方法评价肾上腺髓质素前体中段肽对心力衰竭(心衰)患者全因死亡率的影响。方法检索PubMed、EMbase、Web of Science和The Cochrane Library、中国期刊全文数据库、维普数据库和万方数字化期刊全文数据库,搜集肾上腺髓质素前体中段肽对心衰患者全因死亡率的前瞻性研究,检索时限均为建库至2020年5月23日。由两名研究者独立筛选文献后提取数据进行评价,并对研究人群、危险比因素、随访时间进行亚组分析,评估肾上腺髓质素前体中段肽对心衰患者预后预测价值。所有数据采用STATA 16.0软件进行Meta分析。结果共纳入12项前瞻性队列研究,包括5950例心衰患者。Meta分析结果显示:肾上腺髓质素前体中段肽水平升高与心衰患者死亡风险增加相关(HR=1.86,95%CI:1.68~2.06)。结论肾上腺髓质素前体中段肽水平的升高与心衰患者不良预后有关。肾上腺髓质素前体中段肽水平对于心衰患者的预后有着稳定、敏感、独立的预测价值,可作为心衰患者风险分层及预后的特异性指标。指南推荐强度可考虑适当上升。

Objective To review the influence of mid-regional pro-adrenomedullin(MR-proADM)on all-cause mortality in patients with heart failure(HF).Methods The databases of PubMed,EMbase,Web of Science,Cochrane Library,CNKI,VIP and WanFang Data were retrieved for collecting the prospective studies related to influence of MR-proADM on all-cause mortality in HF patients from database establishment time to May 23,2020.The literatures were screened and data was extracted by 2 researchers independently.A subgroup analysis was conducted in terms of study population,hazard ratio factors and follow-up time,and predictive value of MR-proADM to prognosis in HF patients was reviewed.All data was given a Meta-analysis by using STATA 16.0.Results There were totally 12 prospective cohort studies included involved 5950 patients.The results of Meta-analysis showed that higher level of MR-proADM was correlated to the increase of death risk in HF patients(HR=1.86,95%CI:1.68~2.06).Conclusion The higher level of MR-proADM is correlated to poor prognosis in HF patients.MR-proADM has stable,sensitive and independent predictive value to prognosis,and it can taken as a specific index for risk stratification and prognosis in HF patients.