Department of Neurology, Jinling Hospital, Southern Medical University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, No. 62, South Huai'an Road, Huai'an, 223002, Jiangsu, China.
Cell Mol Neurobiol. 2019 Nov;39(8):1201-1206. doi: 10.1007/s10571-019-00714-3. Epub 2019 Jul 22.
Trimethylamine N-oxide (TMAO) has emerged as a newly identified gut microbiota-dependent metabolite contributing to a variety of diseases, such as diabetes, atherosclerosis, and cardiovascular diseases. The aim of our study was to determine whether a relatively high TMAO level is associated with an increased risk of poor outcome in ischemic stroke patients. From June 2018 to December 2018, we prospectively recruited acute ischemic stroke patients diagnosed within 24 h of symptom onset. The plasma TMAO level was measured at admission for all patients. Functional outcome was evaluated at 3 months after the stroke using the modified Rankin Scale (mRS) and then dichotomized as favorable (mRS 0-2) or unfavorable (mRS 3-6). A multivariate logistic regression analysis was conducted to evaluate the association between TMAO concentration and poor functional outcome and mortality at 3 months. Of the 225 acute ischemic stroke patients included in the analysis, the median TMAO concentration was 3.8 µM (interquartile range, 1.9-4.8 µM). At 3 months after admission, poor functional outcome was observed in 116 patients (51.6%), and 51 patients had died (22.7%). After adjusting for potential confounders, patients with TMAO levels in the highest quartile were more likely to have higher risks of poor functional outcome [compared with the lowest quartile, odds ratio (OR) 3.63; 95% confidence interval (CI) 1.34-9.82; P = 0.011] and mortality (OR 4.27; 95% CI 1.07-17.07; P = 0.040). Our data suggest that a high plasma TMAO level upon admission may predict unfavorable clinical outcomes in acute ischemic stroke patients.
三甲胺 N-氧化物（TMAO）已被确定为一种新的与肠道微生物群相关的代谢物，与多种疾病有关，如糖尿病、动脉粥样硬化和心血管疾病。我们的研究目的是确定相对较高的 TMAO 水平是否与缺血性脑卒中患者预后不良的风险增加有关。 2018 年 6 月至 2018 年 12 月，我们前瞻性招募了在症状发作后 24 小时内确诊的急性缺血性脑卒中患者。所有患者入院时均测定血浆 TMAO 水平。采用改良 Rankin 量表（mRS）在脑卒中后 3 个月评估功能结局，并将其分为有利（mRS 0-2）或不利（mRS 3-6）。采用多变量逻辑回归分析评估 TMAO 浓度与 3 个月时不良功能结局和死亡率之间的关系。 在纳入分析的 225 例急性缺血性脑卒中患者中，TMAO 浓度中位数为 3.8µM（四分位距，1.9-4.8µM）。入院后 3 个月，116 例患者（51.6%）功能结局不良，51 例患者死亡（22.7%）。调整潜在混杂因素后，TMAO 水平最高四分位的患者发生不良功能结局的风险更高[与最低四分位相比，比值比（OR）3.63；95%置信区间（CI）1.34-9.82；P=0.011]和死亡率（OR 4.27；95%CI 1.07-17.07；P=0.040）。我们的数据表明，急性缺血性脑卒中患者入院时较高的血浆 TMAO 水平可能预示着不良的临床结局。
