胆碱代谢途径相关营养素及代谢物与急性缺血性脑卒中后认知障碍

Choline Pathway Nutrients and Metabolites and Cognitive Impairment After Acute Ischemic Stroke.

机构信息

Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (C.Z., Z.L., B.C., S.Q., X.Z., A.W., T.X., Y.Z.).

Department of Epidemiology, School of Public Health, Chongqing Medical University, China (X.B.).

出版信息

Stroke. 2021 Mar;52(3):887-895. doi: 10.1161/STROKEAHA.120.031903. Epub 2021 Jan 20.

DOI:10.1161/STROKEAHA.120.031903

PMID:33467878

Abstract

BACKGROUND AND PURPOSE

Choline metabolism was suggested to play pathophysiological roles in nervous system and atherosclerosis development. However, little is known about the impacts of choline pathway nutrients and metabolites on poststroke cognitive impairment. We aimed to prospectively investigate the relationships between circulating choline, betaine, and trimethylamine N-oxide with cognitive impairment among acute ischemic stroke patients.

METHODS

We derived data from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). Plasma choline, betaine, and trimethylamine N-oxide concentrations at baseline were measured in 617 participants. Cognitive impairment was evaluated using the Mini-Mental State Examination and the Montreal Cognitive Assessment. Reclassification and calibration of models with choline-related biomarkers were evaluated.

RESULTS

Plasma choline and betaine were inversely associated with cognitive impairment. Compared with the lowest tertile, adjusted odds ratios of Mini-Mental State Examination-defined cognitive impairment for participants in the highest tertiles of choline and betaine were 0.59 (95% CI, 0.39-0.90) and 0.60 (95% CI, 0.39-0.92), respectively. In addition, both choline and betaine offered incremental predictive ability over the basic model with established risk factors, shown by increase in net reclassification improvement and integrated discrimination improvement. There were similar significant relationships between choline and betaine with cognitive impairment as defined by the Montreal Cognitive Assessment. However, plasma trimethylamine N-oxide was only associated with cognitive impairment evaluated using the Mini-Mental State Examination; the adjusted odds ratio was 1.33 (95% CI, 1.04-1.72) for each 1-SD increment of trimethylamine N-oxide.

CONCLUSIONS

Patients with higher choline and betaine levels had lower risk of cognitive impairment after ischemic stroke, supporting promising prognostic roles of choline pathway nutrients for poststroke cognitive impairment.

摘要

背景与目的

胆碱代谢被认为在神经系统和动脉粥样硬化发展中发挥病理生理作用。然而，人们对胆碱途径营养物和代谢物对卒中后认知障碍的影响知之甚少。我们旨在前瞻性研究急性缺血性卒中患者循环胆碱、甜菜碱和三甲胺 N-氧化物与认知障碍之间的关系。

方法

我们从 CATIS（中国急性缺血性卒中降压试验）中提取数据。在 617 名参与者中测量了基线时的血浆胆碱、甜菜碱和三甲胺 N-氧化物浓度。使用简易精神状态检查和蒙特利尔认知评估评估认知障碍。评估了基于胆碱相关生物标志物的模型的再分类和校准。

结果

血浆胆碱和甜菜碱与认知障碍呈负相关。与最低三分位相比，胆碱和甜菜碱最高三分位的参与者中，简易精神状态检查定义的认知障碍的调整比值比分别为 0.59（95%CI，0.39-0.90）和 0.60（95%CI，0.39-0.92）。此外，胆碱和甜菜碱均提供了比基本模型（包含已确立的危险因素）更高的预测能力，表现在净重新分类改善和综合鉴别改善方面。胆碱和甜菜碱与蒙特利尔认知评估定义的认知障碍之间也存在类似的显著关系。然而，只有血浆三甲胺 N-氧化物与使用简易精神状态检查评估的认知障碍相关；每增加 1-SD 的三甲胺 N-氧化物，调整后的比值比为 1.33（95%CI，1.04-1.72）。