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【JCEM】脂联素预测高危患者的心血管事件及死亡
Context: The prognostic value of plasma levels of adiponectin, an adipocytokine with antiatherogenic, antiinflammatory, and insulin-sensitizing effects, is contentious.
Objective: The objective of the study was to investigate whether plasma adiponectin levels predict cardiovascular (CV) events and mortality in high-risk coronary artery disease (CAD) patients.
Design, Setting, Participants, and Main Outcome Measure: We measured plasma adiponectin and examined its impact on the incidence of CV deaths and events at follow-up in the context of all potentially relevant background covariates in 712 high-risk patients of the Genetic and ENvironmental factors in Coronary Atherosclerosis study who underwent coronary angiography for suspected CAD. Based on the population plasma adiponectin median (6.38 μg/ml, interquartile range 4.2–10.2), we split the patients in a high- and a low-plasma adiponectin subgroup. After a median follow-up of 3.8 years (interquartile range 3.3–4.3 yr), outcome data were obtained in 100% of the patients and 45 CV deaths (6.4%) were recorded. Kaplan-Meier analysis unexpectedly showed a higher CV death rate in high-plasma adiponectin than low-plasma adiponectin patients. By contrast, multivariate Cox regression analysis, in which potential confounders, including ongoing medical treatment, were considered, showed no impact of plasma adiponectin on CV death. Similar negative results were obtained using the propensity score that considered all relevant covariables and medical treatment rate, which differed between the high- and low-plasma adiponectin group.
Conclusions: In high-risk CAD patients, plasma adiponectin above the median (6.38 μg/ml) implies a paradoxical higher risk of CV death. However, when relevant covariates that differ between high- and low-plasma adiponectin groups are considered, this association wanes, indicating that the clustering of plasma adiponectin with other covariates can abolish its impact on CV prognosis. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Plasma Adiponectin for Prediction of Cardiovascular Events and Mortality in High-Risk Patients
血浆脂联素在高危患者的心血管事件和死亡率中之预测地位
Context: The prognostic value of plasma levels of adiponectin, an adipocytokine with antiatherogenic, antiinflammatory, and insulin-sensitizing effects, is contentious.
背景:血浆脂联素(一种具有抗动脉粥样硬化,抗炎,胰岛素增敏效应的脂肪因子)水平的高低与其预后的关系尚有争议.
Objective: The objective of the study was to investigate whether plasma adiponectin levels predict cardiovascular (CV) events and mortality in high-risk coronary artery disease (CAD) patients.
目的:该研究的目的在于考察血浆脂联素水平对于冠心病高危患者中的心血管事件和死亡率的预测作用
Design, Setting, Participants, and Main Outcome Measure: We measured plasma adiponectin and examined its impact on the incidence of CV deaths and events at follow-up in the context of all potentially relevant background covariates in 712 high-risk patients of the Genetic and ENvironmental factors in Coronary Atherosclerosis study who underwent coronary angiography for suspected CAD.
我们抽取了参与冠状动脉粥样硬化研究的712名具备所有潜在可能的基因或环境因素背景影响并对疑诊者进行了冠状动脉造影的高危患者,对他们的血浆脂联素水平对心血管事件和死亡率的影响进行了检测
Based on the population plasma adiponectin median (6.38 μg/ml, interquartile range 4.2–10.2), we split the patients in a high- and a low-plasma adiponectin subgroup. After a median follow-up of 3.8 years (interquartile range 3.3–4.3 yr), outcome data were obtained in 100% of the patients and 45 CV deaths (6.4%) were recorded. Kaplan-Meier analysis unexpectedly showed a higher CV death rate in high-plasma adiponectin than low-plasma adiponectin patients. By contrast, multivariate Cox regression analysis, in which potential confounders, including ongoing medical treatment, were considered, showed no impact of plasma adiponectin on CV death. Similar negative results were obtained using the propensity score that considered all relevant covariables and medical treatment rate, which differed between the high- and low-plasma adiponectin group.
试验的设计,操作,参与者及主要的结果,评价:在这个人群中,血浆脂联素中位数为6.38 μg/ml, 四分位距4.2–10.2.我们将所有患者按血浆脂联素的水平分为高和低两个亚组.对他们进行了平均3.8年的随访(四分位距为3.3–4.3年),纪录全部患者的相关数据,包括45例因心血管事件死亡(占6.4%)的患者.令人始料未及的是,Kaplan-Meier分析提示相对于低血浆水平的脂联素患者来说,高血浆脂联素水平的患者存在较高心血管死亡率.而与之相反的是,通过多元COX回归分析在充分考虑到各种可能的混淆因素(包括正在进行的药物治疗措施等)后认为血浆脂联素水平与心血管死亡率无关.综合所有可能与之相关的协同因素和药物治疗率,运用倾向性积分亦取得相似的阴性结果,这些结果在高血浆脂联素水平组和低血浆脂联素水平组中是不一样的
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作者:admin@医学,生命科学 2010-10-27 17:11
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