Biomarker of Collagen Turnover (C-Terminal Telopeptide) and Prognosis in Patients With Non- ST -Elevation Acute Coronary Syndromes.
Biomarker of Collagen Turnover (C-Terminal Telopeptide) and Prognosis in Patients With Non- ST -Elevation Acute Coronary Syndromes.
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胶原蛋白周转的生物标志物（C 端端肽）和非 ST 段抬高急性冠状动脉综合征患者的预后。
DOI：
10.1161/jaha.118.011444
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发表时间：
2019
影响因子：
5.4
通讯作者：
Morrow,DavidA
中科院分区：
文献类型：
--
作者：
Zelniker,ThomasA;Jarolim,Petr;Scirica,BenjaminM;Braunwald,Eugene;Park,Jeong-Gun;Das,Saumya;Sabatine,MarcS;Morrow,DavidA
小型研究表明，胶原蛋白转化标志物与心力衰竭（HF）的不良结局之间存在关联。我们检测了C -末端末端肽（β - CTx）和非st段抬高急性冠状动脉综合征患者心血管死亡或新发或恶化HF的风险。方法和结果在一项来自非st段抬高急性冠状动脉综合征患者的研究中，我们通过巢式生物标志物分析（N =4094）测量了基线血清β - CTx、NT - proBNP （N -末端前B型利钠肽）、hsTnT（高敏感性心肌肌钙蛋白T）和hsCRP（高敏感性C反应蛋白）（罗氏诊断）。在中位随访时间为12个月期间，采用调整后的Cox模型分析β - CTx四分位数与心血管死亡或心衰之间的关系。较高的β - CTx水平表明心血管死亡/心衰的风险显著增加（第四季度10.9% vs第一季度3.8%,LogrankP<0.001）。多变量校正后，前四分位数（Q4）的β‐CTx与心血管死亡/HF （Q4 vs Q1：校正风险比2.22[1.50-3.27]）及其组成部分（Q4 vs Q1：心血管死亡：校正风险比2.48 [1.46-4.21]；HF：校正风险比2.04[1.26-3.30]）相关。在包括NT‐proBNP、hsTnT和hsCRP在内的校正多标志物模型中，β‐CTx仍然与心血管死亡/HF独立相关（Q4 vs Q1：校正风险比1.98[1.34-2.93]）及其组成部分。β‐CTx与NT‐proBNP （r=0.17，P<0.001）和左心室射血分数（r= - 0.05，P=0.008）呈弱相关性，与hsTnT （r=0.02，P=0.20）或hsCRP （r= - 0.03，P=0.09）无相关性。结论β - CTx（胶原转换的生物标志物）水平与非st段抬高急性冠状动脉综合征患者的心血管死亡和HF相关。该生物标志物与心血管死亡和心衰的传统生物标志物相关性较弱或不显著，可能为这些患者提供补充的病理生物学见解和风险分层。
BackgroundSmall studies have suggested an association between markers of collagen turnover and adverse outcomes in heart failure (HF). We examined C‐terminal telopeptide (beta‐CTx) and the risk of cardiovascular death or new or worsening HF in non–ST‐elevation acute coronary syndrome.Methods and ResultsWe measured baseline serum beta‐CTx, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), hsTnT (high‐sensitivity cardiac troponin T) and hsCRP (high‐sensitivity C‐reactive protein) (Roche Diagnostics) in a nested biomarker analysis (n=4094) from a study of patients with non–ST‐elevation acute coronary syndrome. The relationship between quartiles of beta‐CTx and cardiovascular death or HF over a median follow‐up time of 12 months was analyzed using adjusted Cox models. Higher beta‐CTx levels identified a significantly higher risk of cardiovascular death/HF (Q4 10.9% versus Q1 3.8%, LogrankP<0.001). After multivariable adjustment, beta‐CTx in the top quartile (Q4) was associated with cardiovascular death/HF (Q4 versus Q1: adjusted hazard ratio 2.22 [1.50–3.27]) and its components (Q4 versus Q1: cardiovascular death: adjusted hazard ratio 2.48 [1.46–4.21]; HF: adjusted hazard ratio 2.04 [1.26–3.30]). In an adjusted multimarker model including NT‐proBNP, hsTnT, and hsCRP, beta‐CTx remained independently associated with cardiovascular death/HF (Q4 versus Q1: adjusted hazard ratio 1.98 [1.34–2.93]) and its components. Beta‐CTx correlated weakly with NT‐proBNP (r=0.17,P<0.001) and left ventricular ejection fraction (r=−0.05,P=0.008) and did not correlate with hsTnT (r=0.02,P=0.20), or hsCRP (r=−0.03,P=0.09).ConclusionsLevels of beta‐CTx, a biomarker of collagen turnover, were associated with cardiovascular death and HF in patients with non–ST‐elevation acute coronary syndrome. This biomarker, which correlated only weakly or not significantly with traditional biomarkers of cardiovascular death and HF, may provide complementary pathobiological insight and risk stratification in these patients.