颈动脉支架置入术后与缺血性脑损伤相关的三甲基胺氧化物升高。
Elevated trimethylamine -oxide related to ischemic brain lesions after carotid artery stenting.
机构信息
From the Departments of Neurology (C.W., W.Z., M.R., Q.M., H.S., R.M.), Neurosurgery (C.L., F.Y., X.J.), and Emergency (S.L.), Xuanwu Hospital Capital Medical University, Beijing; Department of Neurology (N.X., Y. Lian, X.C., L. Zhang), The First Affiliated Hospital of Zhengzhou University; Department of Neurology (L. Zhou), Luzhou People's Hospital; Department of Neurology (X.X.), Zigong First People's Hospital; Department of Neurology (Y. Liang), Xiangtan Central Hospital; and Department of Neurology (L.W.), Guizhou Provincial People's Hospital, China.
出版信息
Neurology. 2018 Apr 10;90(15):e1283-e1290. doi: 10.1212/WNL.0000000000005298. Epub 2018 Mar 14.
OBJECTIVES
To investigate whether the plasma level of trimethylamine -oxide (TMAO), a proatherosclerotic intestinal microbiota metabolite, can be a predictor of ischemic brain injury secondary to carotid artery stenting (CAS).
METHODS
In this multicenter, prospective cohort study, we enrolled patients with severe carotid artery stenosis (>70%) who were prepared for CAS. Plasma TMAO level was measured within 3 days before CAS, and MRI was performed 1 to 3 days after CAS.
RESULTS
The mean age of the 268 eligible patients was 64.4 years. New lesions on diffusion-weighted imaging (DWI) were detected in 117 patients (43.7%). TMAO level was higher in patients with new (DWI) lesions than in patients without new lesions (median 5.2 vs 3.2 µmol/L; < 0.001). Increased plasma TMAO levels were associated with an increased risk of having new lesions on DWI after CAS (adjusted odds ratio for the highest vs lowest quartile, 3.85; 95% confidence interval, 1.37-7.56, < 0.001; adjusted odds ratio for the third vs lowest quartile, 1.86; 95% confidence interval, 1.09-4.66, = 0.02). The area under the receiver operating characteristic curve of TMAO was 0.706 for new lesions on DWI, and the optimal cutoff value was 4.29 µmol/L. The sensitivity, specificity, positive predictive value, and negative predictive value of TMAO levels ≥4.29 µmol/L for predicting new lesions on DWI were 61.5%, 74.8%, 65.5%, and 65.5%, respectively.
CONCLUSIONS
Increased TMAO levels are associated with an increased risk of new ischemic brain lesions on post-CAS MRI scans.
目的
探讨肠道菌群代谢产物三甲胺氧化物（trimethylamine -oxide，TMAO）能否预测颈动脉支架置入术（carotid artery stenting，CAS）后缺血性脑损伤。
方法
本多中心前瞻性队列研究纳入了准备行 CAS 的严重颈动脉狭窄（＞70%）患者。于 CAS 前 3 天内测量患者血浆 TMAO 水平，于 CAS 后 1 至 3 天内进行 MRI。
结果
268 例符合条件的患者中，平均年龄为 64.4 岁。117 例患者（43.7%）弥散加权成像（diffusion-weighted imaging，DWI）出现新病灶。与无新发 DWI 病灶的患者相比，有新病灶的患者 TMAO 水平更高（中位数为 5.2μmol/L 比 3.2μmol/L；＜0.001）。血浆 TMAO 水平升高与 CAS 后 DWI 出现新病灶的风险增加相关（最高四分位数与最低四分位数相比，调整后的优势比为 3.85；95%置信区间为 1.37-7.56；＜0.001；第三四分位数与最低四分位数相比，调整后的优势比为 1.86；95%置信区间为 1.09-4.66；=0.02）。TMAO 预测 DWI 新病灶的受试者工作特征曲线下面积为 0.706，最佳截断值为 4.29μmol/L。TMAO 水平≥4.29μmol/L 预测 DWI 新病灶的敏感性、特异性、阳性预测值和阴性预测值分别为 61.5%、74.8%、65.5%和 65.5%。
结论
TMAO 水平升高与 CAS 后 MRI 新缺血性脑病灶风险增加相关。
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