State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China ; Hypertension Division, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China ; Sino-German Laboratory for Molecular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
Arch Med Sci. 2013 Jun 20;9(3):389-97. doi: 10.5114/aoms.2013.35421. Epub 2013 May 28.
Prospective studies about the association between elevated circulating pregnancy-associated plasma protein A (PAPP-A) and adverse vascular events in patients with coronary heart diseases (CHD) are inconsistent. We performed a meta-analysis to clarify this issue.
We identified prospective studies by searching MEDLINE. The vascular outcomes included all-cause mortality, combination of all-cause mortality and non-fatal myocardial infarction (MI), and combined cardiovascular events. Prospective studies providing multivariable adjusted relative risks (RRs) and their 95% confidence intervals (CIs) of pre-mentioned outcomes were included. A random-effects model was used to calculate the pooled RRs. Subgroup and sensitivity analyses were used to explore the potential sources of heterogeneity or modifiable factors.
Fourteen studies with a total of 12 830 participants were included. Elevated PAPP-A level was associated with all-cause mortality (pooled RR 1.74, 95% CI: 1.45 to 2.09, p < 0.001), combined all-cause mortality and non-fatal MI (RR 1.59, 95% CI: 1.37 to 1.85, p < 0.001) and combined cardiovascular events (RR 1.50, 95% CI: 1.22 to 1.85, p < 0.001). There was no significant heterogeneity. Subgroup and sensitivity analyses showed that the positive association was not affected by follow-up term, CHD type, different assay methods of PAPP-A, or studies with less than 5 adjusted variables.
Elevated serum PAPP-A level is associated with adverse vascular outcomes in patients with CHD.
关于循环妊娠相关血浆蛋白 A（PAPP-A）水平升高与冠心病（CHD）患者不良血管事件之间的关联的前瞻性研究结果并不一致。我们进行了一项荟萃分析以阐明这个问题。
我们通过搜索 MEDLINE 确定了前瞻性研究。血管结局包括全因死亡率、全因死亡率和非致死性心肌梗死（MI）的组合以及心血管综合事件。纳入提供上述结局的多变量校正相对风险（RR）及其 95%置信区间（CI）的前瞻性研究。使用随机效应模型计算汇总 RR。亚组和敏感性分析用于探索潜在的异质性来源或可改变的因素。
纳入了 14 项共包含 12830 名参与者的研究。升高的 PAPP-A 水平与全因死亡率（汇总 RR 1.74，95%CI：1.45 至 2.09，p<0.001）、全因死亡率和非致死性 MI 的组合（RR 1.59，95%CI：1.37 至 1.85，p<0.001）以及心血管综合事件（RR 1.50，95%CI：1.22 至 1.85，p<0.001）相关。没有显著的异质性。亚组和敏感性分析表明，阳性关联不受随访期限、CHD 类型、PAPP-A 不同的检测方法或纳入的调整变量少于 5 个的研究的影响。
升高的血清 PAPP-A 水平与 CHD 患者的不良血管结局相关。
