Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou City, People's Republic of China.
Foshan Women and Children's Healthcare Hospital, Foshan City, People's Republic of China.
Sci Rep. 2017 Mar 15;7:44692. doi: 10.1038/srep44692.
Asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase (NOS), impairs the beneficial effect of NO. The predictive value of ADMA for all-cause mortality remains controversial, though it is important in the development of cardiovascular disease (CVD) and progression to dialysis in renal disease. This systematic review and meta-analysis was conducted to investigate the association between circulating ADMA and all-cause mortality. Studies with data pertinent to the association between circulating ADMA and all-cause mortality were reviewed and OR, HR or RR with 95% CI derived from multivariate Cox's proportional-hazards analysis were extracted. A total of 34 studies reporting 39137 participants were included in final analysis. The results demonstrated that circulating ADMA was independently associated with all-cause mortality (RR = 1.27, 95% CI: 1.20-1.34). The association was still statistically significant in patients with pre-existing renal disease (RR = 1.30, 95% CI: 1.19-1.43) and pre-existing CVD (RR = 1.26, 95% CI: 1.16-1.37). In those without pre-existing renal or CVD, ADMA also predicted all-cause mortality (RR = 1.31, 95% CI: 1.13-1.53). The present study suggests a positive association of circulating ADMA with all-cause mortality. Further studies are needed to investigate the effects of interventions on ADMA, and the value of ADMA as a biomarker.
不对称二甲基精氨酸（ADMA）是一种内源性一氧化氮合酶（NOS）抑制剂，会损害 NO 的有益作用。尽管 ADMA 在心血管疾病（CVD）的发展和肾脏疾病进展为透析中很重要，但它对全因死亡率的预测价值仍存在争议。本系统评价和荟萃分析旨在研究循环 ADMA 与全因死亡率之间的关系。对与循环 ADMA 与全因死亡率之间的关系相关的数据进行了研究，并从多变量 Cox 比例风险分析中提取了 OR、HR 或 RR 及其 95%CI。共有 34 项研究报告了 39137 名参与者，最终纳入了分析。结果表明，循环 ADMA 与全因死亡率独立相关（RR=1.27，95%CI：1.20-1.34）。在存在预先存在的肾脏疾病（RR=1.30，95%CI：1.19-1.43）和预先存在的 CVD（RR=1.26，95%CI：1.16-1.37）的患者中，这种相关性仍然具有统计学意义。在没有预先存在的肾脏或心血管疾病的患者中，ADMA 也预测全因死亡率（RR=1.31，95%CI：1.13-1.53）。本研究表明，循环 ADMA 与全因死亡率呈正相关。需要进一步研究干预对 ADMA 的影响，以及 ADMA 作为生物标志物的价值。
