心力衰竭患者血清镁与死亡结局的关联：一项系统评价和荟萃分析。
The association of serum magnesium and mortality outcomes in heart failure patients: A systematic review and meta-analysis.
作者信息
Angkananard Teeranan, Anothaisintawee Thunyarat, Eursiriwan Sudarat, Gorelik Oleg, McEvoy Mark, Attia John, Thakkinstian Ammarin
机构信息
Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Ongkharak, Nakhon Nayok Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University Cardiology Unit, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand Department of Internal Medicine "F", Assaf Harofeh Medical Center (Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Zerifin, Israel Center for Clinical Epidemiology and Biostatistics, The School of Medicine and Public Health, the University of Newcastle, Newcastle, NSW, Australia.
出版信息
Medicine (Baltimore). 2016 Dec;95(50):e5406. doi: 10.1097/MD.0000000000005406.
BACKGROUND
Low serum magnesium (Mg) has been independently shown to increase risk of heart failure (HF), but data on the association between serum Mg concentration and the outcome of patients with HF are conflicting. The purpose of this systematic review and meta-analysis was to estimate the prognostic effects of hypermagnesemia and hypomagnesemia on cardiovascular (CV) mortality and all-cause mortality (ACM) of patients with HF.
METHODS
Relevant studies were identified from Medline and Scopus databases. Included and excluded criteria were defined. Effects (i.e., log [risk ratio [RR]]) of hypomagnesemia and hypermagnesemia versus normomagnesemia were estimated using Poisson regression, and then a multivariate meta-analysis was applied for pooling RRs across studies. Heterogeneity was explored using a meta-regression and subgroup analysis.
RESULTS
On analysis, 7 eligible prospective studies yielded a total of 5172 chronic HF patients with 913 and 1438 deaths from CV and ACM, respectively. Most participants were elderly men with left ventricular (LV) ejection fraction ≤40%. Those patients with baseline hypermagnesemia had a significantly higher risk of CV mortality (RR, 1.38; 95% confidence interval [CI], 1.07-1.78) or ACM (RR, 1.35; 95% CI, 1.18-1.54) than those with baseline normomagnesemia. However, baseline hypomagnesemia was not associated with the risk of CV mortality (RR, 1.11; 95% CI, 0.79-1.57) and ACM (RR, 1.11; 95% CI, 0.87-1.41). A subgroup analysis by Mg cutoff suggested a dose-response trend for hypermagnesemia effects, that is, the pooled RRs for CV mortality were 1.28 (95% CI, 1.05-1.55) and 1.92 (95% CI, 1.00-3.68) for the cutoff of 0.89 to 1.00 and 1.05 to 1.70 mmol/L, respectively.
CONCLUSION
The present systematic review and meta-analysis suggested that, in HF patients, hypermagnesemia with serum Mg ≥ 1.05 mmol/L was associated with an increased risk of CV mortality and ACM but this was not observed for hypomagnesemia. This finding was limited to the elderly patients with chronic HF who had reduced LV systolic function.
背景
低血清镁（Mg）已被独立证明会增加心力衰竭（HF）风险，但血清镁浓度与HF患者预后之间关联的数据存在矛盾。本系统评价和荟萃分析的目的是评估高镁血症和低镁血症对HF患者心血管（CV）死亡率和全因死亡率（ACM）的预后影响。
方法
从Medline和Scopus数据库中识别相关研究。定义了纳入和排除标准。使用泊松回归估计低镁血症和高镁血症与正常镁血症相比的效应（即对数[风险比[RR]]），然后应用多变量荟萃分析汇总各研究的RR。使用荟萃回归和亚组分析探讨异质性。
结果
经分析，7项符合条件的前瞻性研究共纳入5172例慢性HF患者，分别有913例和1438例死于CV和ACM。大多数参与者为老年男性，左心室（LV）射血分数≤40%。那些基线高镁血症患者的CV死亡率（RR，1.38；95%置信区间[CI]，1.07 - 1.78）或ACM（RR，1.35；95%CI，1.18 - 1.54）风险显著高于基线正常镁血症患者。然而，基线低镁血症与CV死亡率（RR，1.11；95%CI，0.79 - 1.57）和ACM（RR，1.11；95%CI，0.87 - 1.41）风险无关。按镁临界值进行的亚组分析显示高镁血症效应存在剂量反应趋势，即CV死亡率的汇总RR在镁临界值为0.89至1.00 mmol/L和1.05至1.70 mmol/L时分别为1.28（95%CI，1.05 - 1.55）和1.92（95%CI，1.00 - 3.68）。
结论
本系统评价和荟萃分析表明，在HF患者中，血清镁≥1.05 mmol/L的高镁血症与CV死亡率和ACM风险增加相关，但低镁血症未观察到这种情况。这一发现仅限于LV收缩功能降低的老年慢性HF患者。
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