Goetze Jens P, Rehfeld Jens F, Alehagen Urban
Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Int J Cardiol. 2016 Apr 15;209:37-41. doi: 10.1016/j.ijcard.2016.02.038. Epub 2016 Feb 3.
Cholecystokinin (CCK) and gastrin are related gastrointestinal hormones with documented cardiovascular effects of exogenous administration. It is unknown whether measurement of endogenous CCK or gastrin in plasma contains information regarding cardiovascular mortality.
Mortality risk was evaluated using Cox proportional hazard regression and Kaplan-Meier analyses. Elderly patients in a primary care setting with symptoms of cardiac disease, i.e. shortness of breath, peripheral edema, and/or fatigue, were evaluated (n=470). Primary care patients were followed for 13years (from 1999); the 5-year all-cause and cardiovascular mortality was used as end point.
In univariate analysis, patients in the 4th CCK quartile had an increased risk of 5-year cardiovascular mortality (hazard ratio 3.9, 95% confidence interval: 2.1-7.0, p<0.0001). In multivariate analysis including established factors associated with cardiovascular mortality, CCK concentrations in the 4th quartile were still associated with increased 5-year cardiovascular mortality risk (HR 3.1, 95% C.I.: 1.7-5.7, p=0.0004), even when including 4th quartile NT-proBNP concentrations in the same model. We observed a marked difference between the genders, where CCK concentrations in the 4th quartile were associated with a higher 5-year cardiovascular mortality in female patients (HR 8.99, 95% C.I.: 3.49-102.82, p=0.0007) compared to men (1.47, 95% C.I.: 0.7-3.3, p=0.35). In contrast, no significant information was obtained from 4th quartile gastrin concentrations on 5-year cardiovascular mortality risk.
CCK in plasma is an independent marker of cardiovascular mortality in elderly female patients. The study thus introduces measurement of plasma CCK in gender-specific cardiovascular risk assessment.
胆囊收缩素（CCK）和胃泌素是相关的胃肠激素，外源性给药时具有已被证实的心血管效应。血浆中内源性CCK或胃泌素的测量是否包含有关心血管死亡率的信息尚不清楚。
使用Cox比例风险回归和Kaplan-Meier分析评估死亡风险。对初级保健机构中出现心脏病症状（即呼吸急促、外周水肿和/或疲劳）的老年患者进行评估（n = 470）。对初级保健患者进行了13年的随访（从1999年开始）；将5年全因死亡率和心血管死亡率用作终点。
在单变量分析中，处于CCK四分位数第4组的患者5年心血管死亡率风险增加（风险比3.9，95%置信区间：2.1 - 7.0，p < 0.0001）。在包括与心血管死亡率相关的既定因素的多变量分析中，即使在同一模型中纳入四分位数第4组的NT - proBNP浓度，四分位数第4组的CCK浓度仍与5年心血管死亡率风险增加相关（HR 3.1，95% C.I.：1.7 - 5.7，p = 0.0004）。我们观察到性别之间存在显著差异，与男性（1.47，95% C.I.：0.7 - 3.3，p = 0.35）相比，四分位数第4组的CCK浓度与女性患者更高的5年心血管死亡率相关（HR 8.99，95% C.I.：3.49 - 102.82，p = 0.0007）。相比之下，四分位数第4组的胃泌素浓度未获得关于5年心血管死亡率风险的显著信息。
血浆CCK是老年女性患者心血管死亡率的独立标志物。因此，该研究引入了血浆CCK测量用于特定性别的心血管风险评估。
