可溶性 Neprilysin 与经皮冠状动脉介入治疗的冠心病患者的长期临床结局：一项回顾性队列研究。

Soluble neprilysin and long-term clinical outcomes in patients with coronary artery disease undergoing percutaneous coronary intervention: a retrospective cohort study.

机构信息

Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, Seoul, Republic of Korea.

出版信息

BMC Cardiovasc Disord. 2020 Aug 6;20(1):360. doi: 10.1186/s12872-020-01636-5.

DOI:10.1186/s12872-020-01636-5

PMID:32762650

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7409669/

Abstract

BACKGROUND

Neprilysin has an essential role in regulating fluid balance and vascular resistance, and neprilysin inhibitors have shown beneficial effects in patients with heart failure. However, the potential predictive value of neprilysin levels as a biomarker for cardiovascular risk remains unclear. The aim of this study was to assess the prognostic value of soluble neprilysin (sNEP) levels in patients with ischemic heart disease.

METHODS

Neprilysin levels were measured in 694 consecutive patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). These patients were classified into two groups according to their serum levels of neprilysin and categorized into the lower neprilysin group (n = 348) and the higher neprilysin group (n = 346). The primary clinical endpoint was all-cause mortality, and the secondary endpoint was a composite of major adverse cardiac events (MACE).

RESULTS

The median sNEP level was 76.0 pg/ml. The median sNEP levels were higher in patients with left ventricular ejection fraction (LVEF) ≥40% (77.6 pg/ml, interquartile range 46.6-141.3) than in those with LVEF < 40% (70.0 pg/ml, interquartile range 47.1-100.6; P = 0.032). Among all patients, each clinical outcome and MACE did not differ significantly according to the groups divided into median, tertile, or quartile of sNEP levels during a median follow-up of 28.4 months. We did not find a significant relationship between sNEP levels and clinical outcomes in multivariate Cox regression analysis. Among patients with LVEF < 40%, an increased sNEP level was associated with a higher rate of all-cause death (adjusted hazard ratio 2.630, 95% confidence interval 1.049-6.595, P = 0.039).

CONCLUSION

Serum sNEP levels are not associated with long-term mortality or cardiovascular outcomes after PCI in patients with CAD. In the LVEF < 40% group, increased sNEP levels may be associated with a higher risk of all-cause death.

摘要

背景

Neprilysin 在调节体液平衡和血管阻力方面起着重要作用，Neprilysin 抑制剂已在心力衰竭患者中显示出有益效果。然而，Neprilysin 水平作为心血管风险生物标志物的潜在预测价值仍不清楚。本研究旨在评估可溶性 Neprilysin（sNEP）水平在缺血性心脏病患者中的预后价值。

方法

对 694 例接受经皮冠状动脉介入治疗（PCI）的冠状动脉疾病（CAD）连续患者进行 Neprilysin 水平检测。根据血清 Neprilysin 水平将这些患者分为两组，并分为低 Neprilysin 组（n=348）和高 Neprilysin 组（n=346）。主要临床终点为全因死亡率，次要终点为主要不良心脏事件（MACE）的复合终点。

结果

sNEP 的中位数为 76.0pg/ml。左心室射血分数（LVEF）≥40%的患者 sNEP 中位数水平较高（77.6pg/ml，四分位距 46.6-141.3），而 LVEF<40%的患者 sNEP 中位数水平较低（70.0pg/ml，四分位距 47.1-100.6；P=0.032）。在所有患者中，在中位数为 28.4 个月的中位随访期间，根据 sNEP 水平的中位数、三分位数或四分位数将患者分为不同组后，每个临床结局和 MACE 没有显著差异。多变量 Cox 回归分析并未发现 sNEP 水平与临床结局之间存在显著关系。在 LVEF<40%的患者中，sNEP 水平升高与全因死亡发生率较高相关（调整后的危险比 2.630，95%置信区间 1.049-6.595，P=0.039）。