作者：刘乘光，徐巧茜，陈楚寒，宁桂兰

单位：

1.530000广西壮族自治区南宁市，广西中医药大学 2.530000广西壮族自治区南宁市，广西中医药大学附属瑞康医院心血管内科 通信作者：宁桂兰，E-mail：guilanning@yeah.net

Units：

1.Guangxi University of Chinese Medicine, Nanning 530000, China 2.Department of Cardiovascular Medicine, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530000, China Corresponding author: NING Guilan, E-mail: guilanning@yeah.net

关键词：

心力衰竭; 同型半胱氨酸; 数据相关性; Meta分析;

Keywords：

Heart failure; Homocysteine; Correlation of data; Meta-analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.016

Funds：

国家自然科学基金资助项目（82160875）；广西中医药大学高层次人才团队培育项目——中医药系统生物学创新研究团队（2021005）

摘要：

目的 采用Meta分析方法评价血清同型半胱氨酸（Hcy）水平与心力衰竭（HF）相关指标的相关性。方法 计算机检索Pub Med、Embase、Cochrane Library、中国知网、维普网、万方数据知识服务平台和中国生物医学文献数据库公开发表的血清Hcy水平与HF相关指标相关性的研究，检索时限为建库至2022年3月。由2名研究者根据纳入与排除标准独立筛选文献、提取资料并交叉核对，采用纽卡斯尔-渥太华量表（NOS）独立评价纳入文献的质量，采用Rev Man 5.4软件进行Meta分析。结果 最终纳入文献68篇，其中中文文献66篇、英文文献2篇，总样本量为7 058例。Meta分析结果显示，HF患者血清Hcy水平与N末端脑钠肽前体（NT-proBNP）、脑钠肽（BNP）、左心室舒张末期内径（LVEDD）、左心室舒张末期容积（LVEDV）、左心室质量指数（LVMI）、左心室后壁厚度（LVPWT）、E/A比值、室间隔基底段厚度（IVS）、纽约心脏病协会（NYHA）分级呈正相关，与左心室射血分数（LVEF）呈负相关（P<0.05）。敏感性分析结果显示，逐一剔除文献后Meta分析结果基本一致，表明结果基本可靠。根据患者年龄进行亚组分析，结果显示，<60岁、≥60岁HF患者血清Hcy水平与NT-proBNP、BNP、LVEDD均呈正相关，与LVEF均呈负相关（P<0.05）。根据患者来源（地区）进行亚组分析，结果显示：我国南方、我国北方、国外HF患者血清Hcy水平与NT-proBNP均呈正相关（P<0.05）；我国南方、我国北方HF患者血清Hcy水平与BNP、LVEDD均呈正相关，与LVEF均呈负相关（P<0.05）。发表偏倚分析结果显示，报道HF患者血清Hcy水平与NT-proBNP、BNP、LVEF、LVEDD、NYHA分级相关性文献的漏斗图散点分布基本对称，提示不存在发表偏倚。结论 HF患者血清Hcy水平与NT-proBNP、BNP、LVEDD、LVEDV、LVMI、LVPWT、E/A比值、IVS、NYHA分级呈正相关，与LVEF呈负相关；且血清Hcy水平与NT-proBNP、BNP、LVEF、LVEDD之间的关系不受年龄、地区影响。

Abstract：

【Abstract】 Objective To evaluate the correlation between serum homocysteine (Hcy) level and heart failure (HF) related indexes using Meta-analysis. Methods The published studies on the correlation between serum Hcy level and HF related indexes in PubMed, Embase, Cochrane Library, CNKI, VIP, Wanfang Data and Chinese Biomedical Database were searched by computer, and the retrieval period was from the establishment of the database to March 2022. References were independently screened, data were extracted and cross-checked by two researchers according to inclusion and exclusion criteria. The quality of the included references was independently evaluated using Newcastle-Ottawa Scale (NOS) . Meta-analysis was performed using RevMan 5.4 software. Results Sixty-eight literature were included, including 66 in Chinese and 2 in English, with a total sample size of 7 058 cases. The results of the Meta-analysis showed that serum Hcy level was positively correlated with N-terminal pro-brain natriuretic peptide (NT-proBNP) , brain natriuretic peptide (BNP) , left ventricular end diastolic diameter (LVEDD) , left ventricular end-diastolic volume (LVEDV) , left ventricular mass index (LVMI) , left ventricular posterior wall thickness (LVPWT) , E/A ratio, interventricular septum thickness (IVS) and New York Heart Association (NYHA) grade and negatively correlated with left ventricular ejection fraction (LVEF) in HF patients (P < 0.05) . The results of sensitivity analysis showed that the Meta-analysis results were largely consistent after excluding the literature one by one, indicating that the results were largely reliable. Subgroup analysis was conducted according to the age of patients, and the results showed that serum Hcy level was positively correlated with NT-proBNP, BNP and LVEDD, and negatively correlated with LVEF in HF patients < 60 years old and ≥ 60 years old (P < 0.05) . Subgroup analysis was conducted according to the source (region) of the patients, and the results showed that the serum Hcy level was positively correlated with NT-proBNP in HF patients in the south of China, the north of China and foreign countries (P < 0.05) ; the serum Hcy level was positively correlated with BNP and LVEDD, and negatively correlated with LVEF in HF patients in the south and north of China (P < 0.05) . The results of publication bias analysis showed that the funnel plot scatter distribution of literature reporting the correlation between serum Hcy level and NT-proBNP, BNP, LVEF, LVEDD and NYHA grade in HF patients was basically symmetric, suggesting no publication bias. Conclusion Serum Hcy level in HF patients is positively correlated with NT-proBNP, BNP, LVEDD, LVEDV, LVMI, LVPWT, E/A ratio, IVS, NYHA grade, and negatively correlated with LVEF. The relationship between serum Hcy level and NT proBNP, BNP, LVEF and LVEDD in HF patients is not affected by age or region.

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