University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA.
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Curr Nutr Rep. 2018 Dec;7(4):207-213. doi: 10.1007/s13668-018-0252-z.
Trimethylamine N-oxide (TMAO) is a gut microbiota-dependent metabolite produced from choline and phosphatidylcholine. Trimethylamine N-oxide was found associated with enhanced atherosclerosis and thrombosis in vitro and in vivo. We summarized available clinical studies which investigated TMAO's role in predicting prognostic outcomes, including mortality, in patients with cardiovascular diseases.
In chronic kidney disease cohorts, higher TMAO levels were significantly associated with higher mortality from 1.18 to 4.32 folds. Higher TMAO levels were not significantly associated with mortality in patient undergoing dialysis. In patients with peripheral artery disease, higher TMAO levels were associated with higher overall mortality from 1.38 to 2.06 folds. In patients with type 2 diabetes, higher TMAO levels were significantly associated with higher overall mortality 2.07 to 2.7 folds. In patients with heart failure, higher TMAO levels were associated with higher mortality or cardiac transplantation 1.18 to 1.79 folds. TMAO levels could potentially be integrated to existed risk stratification tools and could lead to novel prevention and treatment approaches to cardiovascular disease. Nonetheless, more studies would be needed to clarify predictive value of TMAO to specific groups of patients. Mechanisms how TMAO affect atherosclerosis and confounding effects of TMAO with traditional cardiovascular parameters should also be further investigated.
三甲胺 N-氧化物（TMAO）是一种肠道微生物依赖性代谢产物，由胆碱和磷脂酰胆碱产生。TMAO 被发现与体外和体内增强的动脉粥样硬化和血栓形成有关。我们总结了目前已有的临床研究，这些研究调查了 TMAO 在预测心血管疾病患者预后结局（包括死亡率）方面的作用。
在慢性肾脏病队列中，TMAO 水平较高与死亡率升高相关，风险比为 1.18 至 4.32 倍。在接受透析的患者中，TMAO 水平与死亡率升高无关。在周围动脉疾病患者中，TMAO 水平较高与总死亡率升高相关，风险比为 1.38 至 2.06 倍。在 2 型糖尿病患者中，TMAO 水平与总死亡率升高相关，风险比为 2.07 至 2.7 倍。在心力衰竭患者中，TMAO 水平与死亡率或心脏移植相关，风险比为 1.18 至 1.79 倍。TMAO 水平可能被整合到现有的风险分层工具中，并可能导致心血管疾病的新的预防和治疗方法。然而，还需要更多的研究来阐明 TMAO 对特定患者群体的预测价值。还应进一步研究 TMAO 如何影响动脉粥样硬化以及 TMAO 与传统心血管参数之间的混杂效应。
