Zhai Qijin, Sun Taipeng, Sun Chuanfu, Yan Luxia, Wang Xiang, Wang Yuqian, Sun Junshan, Zhao Ying
Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, 223002, Jiangsu, China.
Department of Medical Psychology, The Third People's Hospital of Huaian, Huai'an, 223002, Jiangsu, China.
Neurol Sci. 2021 Mar;42(3):1009-1016. doi: 10.1007/s10072-020-04618-9. Epub 2020 Jul 23.
As a gut microbiota-dependent metabolite, trimethylamine N-oxide (TMAO) has been implicated in cardiovascular diseases. We aimed to investigate the relationship between the clinical outcomes and plasma TMAO concentrations in patients with acute intracerebral hemorrhage.
From January 2019 to October 2019, we prospectively enrolled intracerebral hemorrhage patients diagnosed within 6 h of symptoms onset. Plasma TMAO levels was measured for all patients within 24 h after admission. The primary outcome was functional outcome at 3 months. Patients were dichotomized as good (modified Rankin scale 0-3) and poor (modified Rankin scale 4-6). Secondary outcome included early neurological deterioration (END) and hematoma enlargement (HE).
There were 307 patients (57.7% male) with a mean age of 66.8 years included in the study. The median TMAO levels was 3.2 μmol/L. END, HE, and 3-month poor outcome were detected in 59 (19.2%), 54 (17.6%), and 139 (45.3%) patients, respectively. After adjusting for potential confounders, the odds ratio for the highest quartile of TMAO compared with the lowest quartile was 3.65 (95% confidence interval, 1.43-9.30) for 3-month poor outcome. Furthermore, multiple-adjusted spline regression model showed a linear association between TMAO levels and poor outcome at 3 months (P = 0.013 for linearity). Similar significant findings were observed when functional outcome was analyzed by continuous mRS score. No association was found between TMAO levels and END and HE.
The present study demonstrated that increased TMAO levels were independently correlated with 3-month function outcome after intracerebral hemorrhage.
作为一种依赖肠道微生物群的代谢产物，氧化三甲胺（TMAO）与心血管疾病有关。我们旨在研究急性脑出血患者的临床结局与血浆TMAO浓度之间的关系。
2019年1月至2019年10月，我们前瞻性纳入了症状发作6小时内确诊的脑出血患者。入院后24小时内对所有患者测量血浆TMAO水平。主要结局是3个月时的功能结局。患者被分为良好（改良Rankin量表0-3分）和不良（改良Rankin量表4-6分）。次要结局包括早期神经功能恶化（END）和血肿扩大（HE）。
本研究纳入了307例患者（男性占57.7%），平均年龄66.8岁。TMAO水平中位数为3.2μmol/L。分别有59例（19.2%）、54例（17.6%）和139例（占45.3%）患者出现END、HE和3个月时的不良结局。在调整潜在混杂因素后，TMAO最高四分位数与最低四分位数相比，3个月不良结局的比值比为3.65（95%置信区间，1.43-9.30）。此外，多重校正样条回归模型显示TMAO水平与3个月时的不良结局呈线性关联（线性检验P=0.013）。当通过连续mRS评分分析功能结局时，观察到类似的显著结果。未发现TMAO水平与END和HE之间存在关联。
本研究表明，脑出血后TMAO水平升高与3个月时的功能结局独立相关。
