Department of Neurology, Xiamen Fifth Hospital, Xiamen, China.
Department of Neuroelectrophysiology, Heilongjiang Province Hospital, Harbin, China.
J Neuroimmunol. 2021 May 15;354:577526. doi: 10.1016/j.jneuroim.2021.577526. Epub 2021 Feb 20.
Over the recent years, the role of trimethylamine N-oxide (TMAO) as a gut-derived metabolite mediating cardiovascular disease pathogenesis has been under particularly intense scrutiny. The aim was to explore whether TMAO levels were associated with clinical severity or functional outcome in Chinese patients with ischemic stroke.
This is a single-center, prospective cohort study from Xiamen, China. We examined the relationship between fasting TMAO and 2 of its nutrient precursors, choline and betaine, vs. 3-month functional outcome and mortality in 351 first-ever patients with acute ischemic stroke.
The median value of the plasma level of TMAO was 6.1 μM (IQR, 3.7-9.9 μM), which was higher than in those control cases (4.0; 2.4-5.9 μM). Patients with a poor outcome and nonsurvivors had significantly increased TMAO levels on admission (P < 0.001). Following adjustments for traditional risk factors, increased TMAO concentrations remained predictive of both poor outcome and mortality risks in stroke patients [e.g., quartiles 4 vs 1, odd ratio 5.65 (95% CI, 2.87-13.45), P < 0.001; and 5.84 (95% CI, 3.05-16.12), P < 0.001, respectively]. In multivariate analysis, TMAO was an independent predictor of functional outcome and mortality and improved the prognostic accuracy of the NIHSS to predict functional outcome (combined areas under the curve, 0.82; 95% CI 0.77-0.89, P = 0.003) and mortality (combined areas under the curve, 0.85; 95% CI: 0.80-0.90, P = 0.002).
Fasting plasma concentrations of gut microbial TMAO are higher in patients with ischemic stroke and portend higher poor functional outcome events and mortality.
近年来，三甲基胺 N-氧化物（TMAO）作为一种肠道衍生代谢物，介导心血管疾病发病机制的作用受到了特别密切的关注。本研究旨在探讨 TMAO 水平与中国缺血性脑卒中患者临床严重程度或功能结局的关系。
这是一项来自中国厦门的单中心前瞻性队列研究。我们研究了空腹 TMAO 及其 2 种营养前体胆碱和甜菜碱与 351 例首次急性缺血性脑卒中患者 3 个月功能结局和死亡率之间的关系。
TMAO 血浆水平的中位数为 6.1 μM（IQR，3.7-9.9 μM），高于对照组（4.0；2.4-5.9 μM）。预后不良和未存活患者入院时 TMAO 水平显著升高（P<0.001）。在校正传统危险因素后，TMAO 浓度升高仍然预测卒中患者的不良预后和死亡风险[例如，四分位 4 与 1 相比，比值比 5.65（95%CI，2.87-13.45），P<0.001；5.84（95%CI，3.05-16.12），P<0.001]。多变量分析显示，TMAO 是功能结局和死亡率的独立预测因子，并提高了 NIHSS 预测功能结局的预后准确性（联合曲线下面积，0.82；95%CI 0.77-0.89，P=0.003）和死亡率（联合曲线下面积，0.85；95%CI：0.80-0.90，P=0.002）。
缺血性脑卒中患者空腹血浆中肠道微生物 TMAO 浓度较高，预示着不良功能结局事件和死亡率较高。
