血浆氧化三甲胺水平与冠心病患者预后关系的荟萃分析

Relationship between plasma trimethylamine N-oxide level and prognosis in patients with coronary heart disease:a meta-analysis

目的系统评价冠心病患者血浆氧化三甲胺(TMAO)水平与主要不良心血管事件(MACE)和全因死亡的关系。方法通过计算机搜索中国知网、万方数据库、Pubmed、Embase、Cochrane Library、Web of Science等公开发表的血浆TMAO水平与冠心病患者发生MACE和全因死亡关系的前瞻性队列研究。检索时限从建库至2023年2月,通过纽卡斯尔-渥太华量表(NOS)进行质量评价后提取纳入文献的相关数据,采用Stata 17.0软件进行荟萃分析及剂量反应关系分析。结果共纳入13篇文献的共12999例患者。荟萃分析结果显示,血浆TMAO水平与冠心病患者发生MACE明显相关(HR=1.79,95%CI:1.53~2.09);亚组分析结果显示,与随访时间≤3年相比,随访时间>3年的冠心病患者发生MACE风险与血浆TMAO水平相关性更高(分别为HR=1.75,95%CI:1.48~2.09;HR=1.95,95%CI:1.38~2.72)。血浆TMAO水平与冠心病患者全因死亡也明显相关(HR=2.15,95%CI:1.55~2.98);亚组分析结果显示,与随访时间≤3年相比,随访时间>3年的冠心病患者全因死亡风险与血浆TMAO水平相关性更高(分别为HR=2.03,95%CI:1.14~3.62;HR=2.10,95%CI:1.59~2.78)。剂量反应分析显示,血浆TMAO水平每升高1μmol/L,MACE发生风险增加4.5%,全因死亡风险增加5.8%。结论血浆TMAO水平与冠心病患者发生MACE和全因死亡风险呈线性剂量反应关系。

Objective To systematically investigate the relationship between plasma trimethylamine N-oxide(TMAO)level and major adverse cardiac event(MACE)or all-cause mortality in patients with coronary heart disease.Methods Databases including CNKI,WanFang Data,Pubmed,Embase,Cochrane Library,Web of Science were searched for prospective cohort studies on the relationship between plasma TMAO level and MACE or all-cause mortality in patients with coronary heart disease from inception to February 2023.The data of the included literatures were extracted and the Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the included literatures.Stata 17.0 was used for meta-analysis and dose-response relationship analysis.Results A total of 13 articles and 15 studies were included,with a total of 12999 patients.The results of meta-analysis showed that plasma TMAO levels were associated with MACE in patients with coronary heart disease(HR=1.79,95%CI:1.53-2.09),and subgroup analysis showed that patients who were followed up for more than 3 years had a higher risk of developing MACE than those followed up for 3 years or less(HR=1.75,95%CI:1.48-2.09;HR=1.95,95%CI:1.38-2.72,respectively).Additionally,plasma TMAO levels were also associated with all-cause mortality(HR=2.15,95%CI:1.55-2.98),and subgroup analysis showed that the risk of all-cause mortality in patients followed up for more than 3 years was markedly higher than those followed up for 3 years or less(HR=2.03,95%CI:1.14-3.62;HR=2.10,95%CI:1.59-2.78).Dose-response analysis showed that the risk of MACE or all-cause mortality increased by 4.5%or 5.8%for every 1.0μmol/L increase of plasma TMAO levels.Conclusions There are linear relationships between plasma TMAO levels and the risk of MACE or all-cause mortality in patients with coronary heart disease.