三甲胺 N-氧化物与非 ST 段抬高型心肌梗死患者的冠状动脉粥样硬化负担相关：SZ-NSTEMI 前瞻性队列研究。
Trimethylamine N-oxide is associated with coronary atherosclerotic burden in non-ST-segment myocardial infarction patients: SZ-NSTEMI prospective cohort study.
作者信息
Waleed Khalid Bin, Tse Gary, Lu Yong-Kang, Peng Chang-Nong, Tu Hong, Ding Li-Gang, Xia Yun-Long, Wu Shu-Lin, Li Xin-Tao, Zhou Hou-Qing, Chen Qi-Ying, Sun Ai-Mei, Altaf Afrasyab, Chang Jun-Lei, Wang Li-Li
机构信息
Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, 518055 Shenzhen, P. R. China.
Shenzhen Key Laboratory of Biomimetic Materials and Cellular Immunomodulation, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 518055 Shenzhen, P. R. China.
出版信息
Rev Cardiovasc Med. 2021 Mar 30;22(1):231-238. doi: 10.31083/j.rcm.2021.01.299.
Trimethylamine N-oxide (TMAO) is reported to accelerate atherosclerosis and the development of adverse cardiac outcomes. Relationship between coronary atherosclerotic burden and TMAO has been examined in stable coronary artery disease and ST-segment elevation myocardial infarction, but not in non-ST-segment elevation myocardial infarction (NSTEMI). We examined the association between TMAO and coronary atherosclerotic burden in NSTEMI. In this prospective cohort study, two groups including NSTEMI (n = 73) and age-sex matched Healthy (n = 35) individuals were enrolled between 2019 and 2020. Coronary atherosclerotic burden was stratified based on the number of diseased coronary vessels and clinical risk scores including SYNTAX and GENSINI. Fasting plasma TMAO was measured by isotope dilution high-performance liquid chromatography. The median plasma TMAO levels were significantly higher in the NSTEMI group than in the Healthy group, respectively (0.59 µM; interquartile range [IQR]: 0.43-0.78 versus 0.42 µM; IQR: 0.33-0.64; = 0.006). Within the NSTEMI group, higher TMAO levels were observed in the multivessel disease (MVD) versus single vessel disease ( = 0.002), and intermediate-high risk (score ≥ 23) versus low risk (score < 23) of SYNTAX ( = 0.003) and GENSINI ( = 0.005). TMAO level remained an independent predictor of MVD (odds ratio [OR]: 5.94, = 0.005), intermediate-high risk SYNTAX (OR: 3.61, = 0.013) and GENSINI scores (OR: 4.60, = 0.008) following adjustment for traditional risk factors. Receiver operating characteristic curve (AUC) analysis for TMAO predicted MVD (AUC: 0.73, 95% confidence interval [Cl]: 0.60-0.86, = 0.002), intermediate-high SYNTAX score (AUC: 0.70, 95% Cl: 0.58-0.82, = 0.003) and GENSINI score (AUC: 0.70, 95% Cl: 0.57-0.83, = 0.005). In all, TMAO levels are independently associated with high coronary atherosclerotic burden in NSTEMI.
据报道，氧化三甲胺（TMAO）会加速动脉粥样硬化及不良心脏结局的发展。在稳定型冠状动脉疾病和ST段抬高型心肌梗死中，已对冠状动脉粥样硬化负担与TMAO之间的关系进行了研究，但在非ST段抬高型心肌梗死（NSTEMI）中尚未进行研究。我们研究了NSTEMI中TMAO与冠状动脉粥样硬化负担之间的关联。在这项前瞻性队列研究中，2019年至2020年期间纳入了两组，包括NSTEMI患者（n = 73）和年龄、性别匹配的健康个体（n = 35）。根据病变冠状动脉血管的数量以及包括SYNTAX和GENSINI在内的临床风险评分对冠状动脉粥样硬化负担进行分层。采用同位素稀释高效液相色谱法测定空腹血浆TMAO。NSTEMI组的血浆TMAO水平中位数显著高于健康组（分别为0.59 μM；四分位间距[IQR]：0.43 - 0.78，而健康组为0.42 μM；IQR：0.33 - 0.64；P = 0.006）。在NSTEMI组中，多支血管病变（MVD）患者的TMAO水平高于单支血管病变患者（P = 0.002），SYNTAX评分中高危（评分≥23）患者的TMAO水平高于低危（评分<23）患者（P = 0.003），GENSINI评分中高危患者的TMAO水平高于低危患者（P = 0.005）。在对传统危险因素进行校正后，TMAO水平仍然是MVD（比值比[OR]：5.94，P = 0.005）、SYNTAX中高危（OR：3.61，P = 0.013）和GENSINI评分（OR：4.60，P = 0.008）的独立预测因素。TMAO的受试者工作特征曲线（AUC）分析预测MVD（AUC：0.73, 95%置信区间[Cl]：0.60 - 0.86，P = 0.002）、SYNTAX中高危评分（AUC：0.70, 95% Cl：0.58 - 0.82，P = 0.003）和GENSINI评分（AUC：0.70, 95% Cl：0.57 - 0.83，P = 0.005）。总之，TMAO水平与NSTEMI中高冠状动脉粥样硬化负担独立相关。
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