Dieplinger Benjamin, Haltmayer Meinhard, Poelz Werner, Mueller Thomas
Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria.
Clin Chim Acta. 2009 Oct;408(1-2):87-91. doi: 10.1016/j.cca.2009.07.014. Epub 2009 Jul 30.
We have previously demonstrated that adiponectin is associated with amino terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with peripheral artery disease (PAD). Furthermore, we have shown that NT-proBNP is a strong predictor of mortality in these patients. The aim of this study was therefore to evaluate the value of adiponectin as long-term prognostic marker in patients with atherosclerotic PAD in the same cohort.
We measured adiponectin serum concentrations in 487 consecutive patients with symptomatic PAD admitted to a tertiary care hospital. The endpoint was defined as all-cause mortality, and the study participants were followed for 5 years.
Of the 487 patients enrolled, 114 died and 373 survived during follow-up. The median adiponectin concentration was higher among decedents than survivors (11.3 vs. 9.1mg/L; p<0.001). Univariate Cox proportional-hazard regression analysis revealed that adiponectin concentrations were associated with 5-year mortality in PAD patients (risk ratio 1.05, 95% CI 1.03-1.07; p<0.001 per 1mg/L increase). Even after adjustment for age, sex, body mass index, estimated glomerular filtration rate, clinical stage of PAD, cardiovascular comorbidity, and other potential confounders, the predictive value of adiponectin serum concentrations remained statistically significant (risk ratio 1.03, 95% CI 1.00-1.05; p=0.030 per 1mg/L increase). However, adiponectin lost its independent association with mortality in symptomatic PAD after additional adjustment for NT-proBNP.
In this study, adiponectin serum concentrations predicted 5-year all-cause mortality in patients with symptomatic PAD independently of other established and emerging outcome predictors. Only after adjustment for NT-proBNP, adiponectin lost its independent predictive value.
我们之前已经证明，在周围动脉疾病（PAD）患者中，脂联素与氨基末端前B型利钠肽（NT-proBNP）相关。此外，我们还表明，NT-proBNP是这些患者死亡率的强有力预测指标。因此，本研究的目的是评估脂联素作为同一队列中动脉粥样硬化性PAD患者长期预后标志物的价值。
我们测量了一家三级护理医院收治的487例有症状PAD连续患者的血清脂联素浓度。终点定义为全因死亡率，研究参与者随访5年。
在纳入的487例患者中，随访期间114例死亡，373例存活。死亡患者的脂联素浓度中位数高于存活患者（11.3对9.1mg/L；p<0.001）。单因素Cox比例风险回归分析显示，脂联素浓度与PAD患者的5年死亡率相关（风险比1.05，95%CI 1.03-1.07；每增加1mg/L，p<0.001）。即使在调整年龄、性别、体重指数、估计肾小球滤过率、PAD临床分期、心血管合并症和其他潜在混杂因素后，血清脂联素浓度的预测价值仍具有统计学意义（风险比1.03，95%CI 1.00-1.05；每增加1mg/L，p=0.030）。然而，在进一步调整NT-proBNP后，脂联素与有症状PAD患者的死亡率失去了独立相关性。
在本研究中，血清脂联素浓度可独立于其他既定和新出现的结局预测指标，预测有症状PAD患者的5年全因死亡率。仅在调整NT-proBNP后，脂联素才失去其独立预测价值。
