血浆神经酰胺与血管性事件相关性的meta分析

Association between Plasma Ceramides and Vascular Events:A Meta-analysis

目的用meta分析方法评价血浆神经酰胺(ceramide,Cer)水平与存在心血管疾病风险因素人群的不良心脑血管事件发生风险之间的相关性。方法计算机检索PubMed、Embase、Web of Science、中国知网、万方和维普数据库,查找评价血浆Cer与不良心血管事件(major adverse cardiovascular events,MACE)或心肌梗死或卒中发生风险相关性的临床研究。利用非随机干预研究偏移风险评估工具(risk of bias in non-randomised studies of interventions,ROBINS-I)进行文献质量评价。Cer指标包括新神经酰胺测试2(ceramide test 2,CERT2)评分及其中包括的不同Cer组分。根据异质性分析结果,分别采用固定或随机效应模型进行不同Cer指标与不良心脑血管事件之间的相关性分析。结果纳入7项针对存在心血管疾病风险因素人群的队列研究,共30886例受试者。meta分析结果显示,CERT2评分内的特定Cer组分Cer(d18∶1/16∶0)(HR 1.13,95%CI 1.02~1.24,P=0.013)是MACE风险升高的独立危险因素,而Cer(d18∶1/24∶0)和Cer(d18∶1/24∶1)与MACE风险无相关性。CERT2评分与单独卒中或心肌梗死发生之间无相关性。结论Cer(d18∶1/16∶0)是MACE的危险因素。CERT2评分可能不能作为预测卒中或心肌梗死的工具。未来仍需高质量临床研究对本结论进一步论证。

Objective To explore the relationship between plasma ceramides(Cer)and risk of cardiocerebrovascular events in patients with cardiovascular risk factors.Methods The databases including PubMed,Embase,Web of Science,CNKI,Wanfang Data and VIP were retrieved to search for the clinical studies involving the association of Cer and the risk of major adverse cardiovascular events(MACE)or stroke or myocardial infarction.A tool for assessing risk of bias in non-randomised studies of interventions(ROBINS-Ⅰ)was used to assess the literature quality in this study.Cer indices included ceramide test 2(CERT2)score and Cer components of CERT2.According to heterogeneity analysis,a fixed or random effect metaanalysis was performed to determine the relationship between the above Cer indices and cardiocerebrovascular events.Results A total of 7 cohort studies including 30886 patients were included in this meta-analysis.The results showed that particular components of Cer(d18:1/16:0)(HR 1.13,95%CI 1.02-1.24,P=0.013)was independent risk factors of MACE.However,no obvious association between Cer(d18:1/24:0)or Cer(d18:1/24:1)and MACE were observed.There were no obvious association between CERT2 and stroke or myocardial infarction.Conclusions Cer(d18:1/16:0)was the risk factor of MACE.CERT2 might not be a robust predictor of stroke or myocardial infarction.