Ang Donald S C, Welsh Paul, Watt Pauline, Nelson Scott M, Struthers Allan, Sattar Naveed
Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Clin Sci (Lond). 2009 Jun 2;117(1):41-8. doi: 10.1042/CS20080506.
Plasma adiponectin is inversely associated with the risk of coronary heart disease in healthy people. However, adiponectin and BNP (B-type natriuretic peptide) are both known to be positively associated with a risk of poor outcome, and with each other, in ACS (acute coronary syndrome) patients. Serial changes in plasma adiponectin and BNP following ACS have not been assessed previously, and may clarify these apparently paradoxical associations. In the present study, adiponectin, BNP, classical risk markers and clinical parameters were measured in plasma from 442 consecutive ACS patients in an urban teaching hospital, with repeat measures at 7 weeks (n=338). Patients were followed-up for 10 months. Poor outcome was defined as mortality or readmission for ACS or congestive heart failure (n=90). In unadjusted analysis, the change in adiponectin (but not baseline or 7-week adiponectin) was significantly associated with the risk of an adverse outcome {odds ratio (OR), 5.42 [95% CI (confidence interval), 2.78-10.55]}. This association persisted after adjusting for classical risk factors and clinical markers, but was fully attenuated by adjusting for the 7-week BNP measurement [OR, 1.13 (95% CI, 0.27-4.92)], which itself remained associated with risk [OR, 5.86 (95% CI, 1.04-32.94)]. Adiponectin and BNP positively correlated at baseline and 7 weeks, and the change in both parameters over 7 weeks also correlated (r=0.39, P<0.001). In conclusion, increases in plasma adiponectin (rather than absolute levels) after ACS are related to the risk of an adverse outcome, but this relationship is not independent of BNP levels. The results of the present study allude to a potential direct or indirect relationship between adiponectin and BNP post-ACS which requires further investigation.
血浆脂联素与健康人群冠心病风险呈负相关。然而，在急性冠脉综合征（ACS）患者中，脂联素和B型利钠肽（BNP）均与不良预后风险呈正相关，且二者之间也呈正相关。此前尚未评估ACS后血浆脂联素和BNP的系列变化情况，而这可能会阐明这些明显矛盾的关联。在本研究中，对一家城市教学医院的442例连续ACS患者的血浆进行了脂联素、BNP、经典风险标志物及临床参数的检测，并在7周时（n = 338）进行了重复检测。对患者进行了10个月的随访。不良预后定义为ACS或充血性心力衰竭导致的死亡或再次入院（n = 90）。在未校正分析中，脂联素的变化（而非基线或7周时的脂联素水平）与不良预后风险显著相关{比值比（OR），5.42 [95%可信区间（CI），2.78 - 10.55]}。在对经典风险因素和临床标志物进行校正后，这种关联依然存在，但在对7周时的BNP测量值进行校正后，这种关联完全减弱[OR，1.13（95% CI，0.27 - 4.92）]，而BNP本身仍与风险相关[OR，5.86（95% CI，1.04 - 32.94）]。脂联素与BNP在基线和7周时呈正相关，且两个参数在7周内的变化也呈相关（r = 0.39，P < 0.001）。总之，ACS后血浆脂联素升高（而非绝对水平）与不良预后风险相关，但这种关系并非独立于BNP水平。本研究结果提示ACS后脂联素与BNP之间可能存在直接或间接关系，这需要进一步研究。
