胰岛素抵抗、脂联素与择期心脏手术后的不良结局：一项前瞻性随访研究。
Insulin resistance, adiponectin and adverse outcomes following elective cardiac surgery: a prospective follow-up study.
作者信息
Mikkelsen Martin M, Hansen Troels K, Gjedsted Jakob, Andersen Niels H, Christensen Thomas D, Hjortdal Vibeke E, Johnsen Søren P
机构信息
Department of Cardiothoracic and Vascular Surgery T & Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
出版信息
J Cardiothorac Surg. 2010 Dec 14;5:129. doi: 10.1186/1749-8090-5-129.
BACKGROUND
Insulin resistance and adiponectin are markers of cardio-metabolic disease and associated with adverse cardiovascular outcomes. The present study examined whether preoperative insulin resistance or adiponectin were associated with short- and long-term adverse outcomes in non-diabetic patients undergoing elective cardiac surgery.
METHODS
In a prospective study, we assessed insulin resistance and adiponectin levels from preoperative fasting blood samples in 836 patients undergoing cardiac surgery. Population-based medical registries were used for postoperative follow-up. Outcomes included all-cause death, myocardial infarction or percutaneous coronary intervention, stroke, re-exploration, renal failure, and infections. The ability of insulin resistance and adiponectin to predict clinical adverse outcomes was examined using receiver operating characteristics.
RESULTS
Neither insulin resistance nor adiponectin were statistically significantly associated with 30-day mortality, but adiponectin was associated with an increased 31-365-day mortality (adjusted odds ratio 2.9 [95% confidence interval 1.3-6.4]) comparing the upper quartile with the three lower quartiles. Insulin resistance was a poor predictor of adverse outcomes. In contrast, the predictive accuracy of adiponectin (area under curve 0.75 [95% confidence interval 0.65-0.85]) was similar to that of the EuroSCORE (area under curve 0.75 [95% confidence interval 0.67-0.83]) and a model including adiponectin and the EuroSCORE had an area under curve of 0.78 [95% confidence interval 0.68-0.88] concerning 31-365-day mortality.
CONCLUSIONS
Elevated adiponectin levels, but not insulin resistance, were associated with increased mortality and appear to be a strong predictor of long-term mortality. Additional studies are warranted to further clarify the possible clinical role of adiponectin assessment in cardiac surgery.
TRIAL REGISTRATION
The Danish Data Protection Agency; reference no. 2007-41-1514.
背景
胰岛素抵抗和脂联素是心脏代谢疾病的标志物，与不良心血管结局相关。本研究旨在探讨术前胰岛素抵抗或脂联素是否与接受择期心脏手术的非糖尿病患者的短期和长期不良结局相关。
方法
在一项前瞻性研究中，我们评估了836例接受心脏手术患者术前空腹血样中的胰岛素抵抗和脂联素水平。使用基于人群的医疗登记系统进行术后随访。结局包括全因死亡、心肌梗死或经皮冠状动脉介入治疗、中风、再次手术探查、肾衰竭和感染。使用受试者工作特征曲线来检验胰岛素抵抗和脂联素预测临床不良结局的能力。
结果
胰岛素抵抗和脂联素与30天死亡率均无统计学显著相关性，但将上四分位数与三个下四分位数相比，脂联素与31至365天死亡率增加相关（调整后的优势比为2.9 [95%置信区间1.3 - 6.4]）。胰岛素抵抗对不良结局的预测能力较差。相比之下，脂联素的预测准确性（曲线下面积为0.75 [95%置信区间0.65 - 0.85]）与欧洲心脏手术风险评估系统（EuroSCORE）的预测准确性（曲线下面积为0.75 [95%置信区间0.67 - 0.83]）相似，并且一个包含脂联素和欧洲心脏手术风险评估系统的模型在预测31至365天死亡率方面的曲线下面积为0.78 [95%置信区间0.68 - 0.88]。
结论
脂联素水平升高而非胰岛素抵抗与死亡率增加相关，并且似乎是长期死亡率的有力预测指标。有必要进行更多研究以进一步阐明脂联素评估在心脏手术中可能的临床作用。
试验注册
丹麦数据保护局；参考编号2007 - 41 - 1514。
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