Department of Neurosurgery, University of Leipzig Medical Center, Leipzig, Germany.
Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany.
Acta Neurochir (Wien). 2023 May;165(5):1277-1287. doi: 10.1007/s00701-022-05485-3. Epub 2023 Jan 25.
It is suspected that microbiome-derived trimethylamine N-oxide (TMAO) may enhance platelet responsiveness and accordingly be thrombophilic. The purpose of this prospective observational study is to evaluate TMAO in patients with subarachnoid hemorrhage (SAH) and compare it with a control group. A secondary aim was to investigate TMAO in the cerebrospinal fluid (CSF) from SAH patients. This should provide a better understanding of the role of TMAO in the pathogenesis of SAH and its thrombotic complications.
The study included patients with diagnosed spontaneous SAH recruited after initial treatment on admission and patients with nerve, nerve root, or plexus disorders serving as controls. Blood samples were gathered from all patients at recruitment. Additionally, sampling of SAH patients in the intensive care unit continued daily for 14 days. The CSF was collected out of existing external ventricular drains whenever possible.
Thirty-four patients diagnosed with SAH, and 108 control patients participated in this study. Plasma TMAO levels at baseline were significantly lower in the SAH group (1.7 μmol/L) compared to the control group (2.9 μmol/L). TMAO was detectable in the CSF (0.4 μmol/L) and significantly lower than in plasma samples of the SAH group at baseline. Plasma and CSF TMAO levels correlated positively. The TMAO levels did not differ significantly during the observation period of 15 days.
Although we assumed that patients with higher TMAO levels were at higher risk for SAH a priori, plasma TMAO levels were lower in patients with SAH compared with control subjects with nerve, nerve root, or plexus disorders on admission to the hospital. A characteristic pattern of plasma TMAO levels in patients with SAH was not found.
微生物衍生的三甲胺 N-氧化物（TMAO）可能增强血小板反应性，因此具有血栓形成倾向。本前瞻性观察研究旨在评估蛛网膜下腔出血（SAH）患者中的 TMAO，并与对照组进行比较。次要目的是研究 SAH 患者的脑脊液（CSF）中的 TMAO。这将有助于更好地了解 TMAO 在 SAH 发病机制及其血栓并发症中的作用。
该研究纳入了在入院初始治疗后确诊为自发性 SAH 的患者，以及患有神经、神经根或神经丛疾病的患者作为对照组。所有患者在入组时均采集血样。此外，在重症监护病房的 SAH 患者每天继续采样 14 天。尽可能从现有的外部脑室引流中采集 CSF。
本研究共纳入 34 例确诊为 SAH 的患者和 108 例对照组患者。SAH 组患者的基线血浆 TMAO 水平（1.7μmol/L）明显低于对照组（2.9μmol/L）。CSF 中可检测到 TMAO（0.4μmol/L），明显低于基线时 SAH 组的血浆样本。血浆和 CSF TMAO 水平呈正相关。在 15 天的观察期内，TMAO 水平无显著差异。
尽管我们假设 TMAO 水平较高的患者发生 SAH 的风险更高，但与患有神经、神经根或神经丛疾病的对照组患者相比，入院时 SAH 患者的血浆 TMAO 水平较低。未发现 SAH 患者血浆 TMAO 水平的特征模式。
