Pratesi Alessandra, Di Serio Claudia, Orso Francesco, Foschini Alice, Bartoli Nadia, Marella Andrea, Fumagalli Stefano, Di Bari Mauro, Marchionni Niccolò, Tarantini Francesca, Baldasseroni Samuele
Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Ageing, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy; Intensive Care Unit, Division of Cardiology, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi (AOUC), Florence, Italy.
Diabetes Res Clin Pract. 2016 Aug;118:58-66. doi: 10.1016/j.diabres.2016.04.003. Epub 2016 Apr 27.
Adiponectin (AD) promotes insulin sensitivity and has anti-atherogenic properties. However, the role of AD on clinical outcomes in coronary artery disease (CAD) is controversial. We analyzed whether AD was an independent predictor of all-cause mortality and hospitalization in patients with CAD.
We prospectively enrolled 138 patients with stable CAD, with or without type 2 diabetes and with or without left ventricular dysfunction. A telephone follow-up was conducted to register long term outcomes. Sensitivity/specificity ratio for AD was investigated with ROC analysis and the independent role of AD on outcome was evaluated with Cox regression model of analysis. The survival rate was represented by Kaplan Meyer curves.
Of 138 patients, 61 had type 2 diabetes and 71 left ventricular systolic dysfunction (EF<40%). Median time of follow-up was 1384days; mortality rate was 18.8% (26 deaths) and hospitalization rate was 47.1% (65 events). Mean concentration of AD was 9.87±7.53ng/ml; the analysis of the ROC curve identified an AD cut-off level of 13.2ng/ml (AUC 0.779; p<0.0001). Patients with AD >13.2ng/ml had a significantly higher risk of death (HR=6.50; 95% CI: 2.40-17.70), but not of cardiovascular hospitalization (HR=0.87; 95% CI: 0.31-2.44). AD predictivity remained significant also in patients with type 2 diabetes and with left ventricular systolic dysfunction.
In stable CAD, an AD value of >13.2ng/ml independently predicts a 6-fold increased risk of all-cause mortality.
脂联素（AD）可促进胰岛素敏感性并具有抗动脉粥样硬化特性。然而，AD在冠状动脉疾病（CAD）临床结局中的作用存在争议。我们分析了AD是否为CAD患者全因死亡率和住院率的独立预测因素。
我们前瞻性纳入了138例稳定型CAD患者，这些患者有或无2型糖尿病，有或无左心室功能障碍。通过电话随访记录长期结局。采用ROC分析研究AD的敏感性/特异性比值，并使用Cox回归分析模型评估AD对结局的独立作用。生存率用Kaplan - Meyer曲线表示。
138例患者中，61例有2型糖尿病，71例有左心室收缩功能障碍（射血分数<40%）。中位随访时间为1384天；死亡率为18.8%（26例死亡），住院率为47.1%（65例事件）。AD的平均浓度为9.87±7.53ng/ml；ROC曲线分析确定AD的临界值为13.2ng/ml（曲线下面积0.779；p<0.0001）。AD>13.2ng/ml的患者死亡风险显著更高（风险比=6.50；95%置信区间：2.40 - 17.70），但心血管住院风险无显著差异（风险比=0.87；95%置信区间：0.31 - 2.44）。在2型糖尿病患者和左心室收缩功能障碍患者中，AD的预测性也仍然显著。
在稳定型CAD中，AD值>13.2ng/ml可独立预测全因死亡率增加6倍。
