冠心病病人血浆氧化三甲胺浓度与不良预后关系的剂量-反应Meta分析

Meta-analysis of Correlation between Plasma TMAO Concentration and Adverse Prognosis in Patients with Coronary Heart Disease

目的:系统评价冠心病病人血浆氧化三甲胺(TMAO)浓度与不良预后关系。方法:计算机检索PubMed、 the Cochrane Library、EMbase、中国知网(CNKI)、万方和维普数据库,检索时限均为建库至2022年4月,由2名研究人员独立筛选文献、提取资料和评价纳入文献的偏倚风险后,采用Stata 16.0软件进行统计分析。结果:最终纳入8项队列研究,样本量12 952例,Meta分析结果显示,血浆TMAO高浓度组血浆TMAO浓度与不良预后发生有关[HR=1.71,95%CI(1.42,2.05),P<0.05]。血浆TMAO浓度是异质性的主要来源,按照TMAO浓度分组进行亚组分析,结果血浆TMAO浓度>3.74μmol/L的冠心病病人血浆TMAO浓度与冠心病不良预后有关,且血浆TMAO浓度每升高1μmol/L,其不良预后的风险增加1.10倍[HR=1.10,95%CI(1.07,1.14)]。结论:现有证据表明,对于冠心病病人,控制TMAO血浆浓度≤3.74μmol/L或可改善病人预后。

Objective:To evaluate the correlation between plasma trimethylamine oxide(TMAO)concentration and adverse prognosis in patients with coronary heart disease(CHD).Methods:PubMed,the Cochrane Library,EMbase,CNKI,Wanfang,and VIP database were searched by computer.Two researchers independently screened the literatures,extracted the data,and evaluated the bias risk of the included literatures.Then Stata 16.0 software was used for statistical analysis.Results:Eight cohorts with a sample size of 12952 were included.Meta-analysis showed that plasma TMAO concentration was associated with adverse prognosis(HR=1.71,95%CI 1.42-2.05,P<0.05)in the group with high plasma TMAO concentration.The results of subgroup analysis showed that plasma TMAO concentration was the main source of heterogeneity.Subgroup analysis was conducted according to TMAO concentration,and it was found that plasma TMAO concentration was significantly correlated with poor prognosis of CHD patients with TMAO concentration>3.74μmol/L.And the risk of adverse outcome increased by 1.10 multiple for every 1μmol/L increase in plasma TMAO concentration(HR=1.10,95%CI 1.07-1.14).Conclusion:Existing research shows that,for CHD patients,controlling plasma TMAO concentration≤3.74μmol/L may improve patient prognosis.