Chu Renzhu, Yu Dawei, Chu Junyi, Lin Mingqiang, Yu Hongbo
1 Department of Interventional Radiology, Wendeng Osteopathy Hospital, Weihai, China.
2 Department of Radiology, Wendeng Osteopathy Hospital, Weihai, China.
Vascular. 2018 Jun;26(3):322-330. doi: 10.1177/1708538117733227. Epub 2017 Sep 24.
Background Asymmetric dimethylarginine is suggested to be a marker of poor prognosis in patients with atherosclerosis. However, the predictive role of circulating asymmetric dimethylarginine for clinical outcome in patients with peripheral arterial disease has not been determined. Aims To quantitatively assess the predictive value of circulating asymmetric dimethylarginine for clinical outcome in patients with peripheral arterial disease in a meta-analysis of prospective cohort studies. Methods Relevant studies were identified by systematically searching of PubMed and Embase databases. A random-effect model was used to synthesize the results. Sensitivity analyses by omitting one study at a time were performed to evaluate the robustness of the results. Results Six studies with 2535 peripheral arterial disease patients were included. Patients with higher circulating asymmetric dimethylarginine at baseline were associated with higher risk of all-cause mortality (adjusted hazard ratio: 1.63, 95% confidence interval: 1.28-2.06, I = 16%), and major adverse cardiovascular events (adjusted hazard ratio: 2.01, 95% confidence interval: 1.08-3.73, I = 78%) as compared with those with lower circulating asymmetric dimethylarginine at baseline. Specifically, every increment of 0.1 µmol/l of asymmetric dimethylarginine was associated with 18% (adjusted hazard ratio: 1.18, 95% confidence interval: 1.06-1.31) increased risk for all-cause mortality and 14% (adjusted hazard ratio: 1.14, 95% confidence interval: 1.04-1.25) increased risk for major adverse cardiovascular disease. Sensitivity analyses by omitting one study at a time did not significantly change the results. Conclusion Higher circulating asymmetric dimethylarginine at baseline may be associated with higher incidence of cardiovascular events and mortality in patients with peripheral arterial disease.
背景 不对称二甲基精氨酸被认为是动脉粥样硬化患者预后不良的标志物。然而，循环中的不对称二甲基精氨酸对周围动脉疾病患者临床结局的预测作用尚未确定。目的 在一项前瞻性队列研究的荟萃分析中，定量评估循环中的不对称二甲基精氨酸对周围动脉疾病患者临床结局的预测价值。方法 通过系统检索PubMed和Embase数据库来确定相关研究。采用随机效应模型来综合结果。通过每次剔除一项研究进行敏感性分析，以评估结果的稳健性。结果 纳入了6项研究，共2535例周围动脉疾病患者。与基线时循环中不对称二甲基精氨酸水平较低的患者相比，基线时循环中不对称二甲基精氨酸水平较高的患者全因死亡风险更高（调整后风险比：1.63，95%置信区间：1.28 - 2.06，I² = 16%），主要不良心血管事件风险更高（调整后风险比：2.01，95%置信区间：1.08 - 3.73，I² = 78%）。具体而言，不对称二甲基精氨酸每增加0.1 μmol/l，全因死亡风险增加18%（调整后风险比：1.18，95%置信区间：1.06 - 1.31），主要不良心血管疾病风险增加14%（调整后风险比：1.14，95%置信区间：1.04 - 1.25）。每次剔除一项研究进行的敏感性分析并未显著改变结果。结论 基线时循环中较高的不对称二甲基精氨酸水平可能与周围动脉疾病患者心血管事件和死亡率的较高发生率相关。
