微生物血栓定植可能影响伴有 ST 段抬高的心肌梗死（STEMI）的高血糖患者的动脉血栓形成。马里内拉研究。
Microbiota thrombus colonization may influence athero-thrombosis in hyperglycemic patients with ST segment elevation myocardialinfarction (STEMI). Marianella study.
机构信息
Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Italy, Italy.
Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy.
出版信息
Diabetes Res Clin Pract. 2021 Mar;173:108670. doi: 10.1016/j.diabres.2021.108670. Epub 2021 Jan 14.
OBJECTIVES
We examined the association of the coronary thrombus microbiota and relative metabolites with major adverse cardiovascular events (MACE) in hyperglycemic patients with ST segment elevation myocardial infarction (STEMI).
BACKGROUND
Hyperglycemia during STEMI may affect both development and progression of coronary thrombus via gut and thrombus microbiota modifications.
METHODS
We undertook an observational cohort study of 146 first STEMI patients treated with primary percutaneous coronary intervention (PPCI) and thrombus-aspiration (TA). Patients were clustered, based on admission blood glucose levels, in hyperglycemic (≥140 mg/dl) and normoglycemic (<140 mg/dl). We analyzed gut and thrombus microbiota in all patients. Moreover, we assessed TMAO, CD40L and von Willebrand Factor (vWF) in coronary thrombi. Cox regressions were used for the association between Prevotellaspp. and TMAO terziles and MACE. MACE endpoint at 1 year included death, re-infarction, unstable angina.
RESULTS
In fecal and thrombus samples, we observed a significantly different prevalence of both Prevotellaspp. and Alistipesspp. between patients with hyperglycemia (n = 56) and those with normal glucose levels (n = 90). The abundance of Prevotella increased in hyperglycemic vs normoglycemic patients whereas the contrary was observed for Alistipes. Interestingly, in coronary thrombus, the content of Prevotella was associated with admission blood glucose levels (p < 0.01), thrombus dimensions (p < 0.01), TMAO, CDL40 (p < 0.01) and vWF (p < 0.01) coronary thrombus contents. Multivariate Cox-analysis disclosed a reduced survival in patients with high levels of Prevotella and TMAO in coronary thrombus as compared to patients with low levels of Prevotella and TMAO, after 1-year follow up.
CONCLUSIONS
Hyperglycemia during STEMI may increase coronary thrombus burden via gut and thrombus microbiota dysbiosis characterized by an increase of Prevotella and TMAO content in thrombi.
CLINICAL TRIAL REGISTRATION
NCT03439592. September 30, 2016. Ethic Committee Vanvitelli University: 268/2016.
目的
我们研究了冠状动脉血栓微生物群及其相关代谢物与高血糖合并 ST 段抬高型心肌梗死（STEMI）患者主要不良心血管事件（MACE）的相关性。
背景
STEMI 期间的高血糖可能通过肠道和血栓微生物群的改变影响冠状动脉血栓的形成和进展。
方法
我们对 146 例接受直接经皮冠状动脉介入治疗（PPCI）和血栓抽吸（TA）的首次 STEMI 患者进行了一项观察性队列研究。根据入院时血糖水平，将患者聚类为高血糖（≥140mg/dl）和正常血糖（<140mg/dl）。所有患者均进行肠道和血栓微生物群分析。此外，我们还评估了冠状动脉血栓中的氧化三甲胺（TMAO）、CD40L 和血管性血友病因子（vWF）。Cox 回归用于分析 Prevotellaspp. 和 TMAO 三分位数与 MACE 的相关性。1 年时的 MACE 终点包括死亡、再梗死、不稳定型心绞痛。
结果
在粪便和血栓样本中，我们观察到高血糖患者（n=56）和血糖正常患者（n=90）之间 Prevotellaspp. 和 Alistipesspp. 的患病率存在显著差异。与血糖正常患者相比，高血糖患者中 Prevotella 的丰度增加，而 Alistipes 的丰度则相反。有趣的是，在冠状动脉血栓中，Prevotella 的含量与入院时血糖水平（p<0.01）、血栓大小（p<0.01）、TMAO、CDL40（p<0.01）和 vWF（p<0.01）相关。多变量 Cox 分析显示，与低水平的 Prevotella 和 TMAO 相比，高水平的 Prevotella 和 TMAO 与冠状动脉血栓中的患者在 1 年随访后的生存率降低有关。
结论
STEMI 期间的高血糖可能通过肠道和血栓微生物群失调增加冠状动脉血栓负担，表现为血栓中 Prevotella 和 TMAO 含量增加。
临床试验注册
NCT03439592。2016 年 9 月 30 日。范维泰利大学伦理委员会：268/2016。
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