氧化三甲胺对脑梗死发病率和预后的影响：一项系统评价和荟萃分析
Effect of TMAO on the incidence and prognosis of cerebral infarction: a systematic review and meta-analysis.
作者信息
Wang Lin, Nan Yinan, Zhu Wenhao, Wang Shaoqing
机构信息
Traditional Chinese Medicine Department, Beijing Tiantan Hospital, Beijing, China.
International Department, China-Japan Friendship Hospital, Beijing, China.
出版信息
Front Neurol. 2024 Jan 8;14:1287928. doi: 10.3389/fneur.2023.1287928. eCollection 2023.
OBJECTIVE
This study aimed to evaluate the effect of trimethylamine oxide (TMAO) on the incidence and prognosis of cerebral infarction.
METHODS
We searched PubMed, Embase, and Cochrane databases for all clinical studies on the association of TMAO with cerebral infarction incidence and prognosis from inception to April 2023. A systematic review and meta-analysis were conducted using the meta-analysis of observational studies in epidemiology (MOOSE) declaration list. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the study. This study protocol was registered on the PROSPERO database with the ID: CRD42023459661. The extracted data included the OR value of the effect of TMAO on the incidence and prognosis of cerebral infarction, the HR value between TMAO and underlying diseases, the RR value, 95% confidence intervals, and the AUC value of TMAO in the prediction model of cerebral infarction.
RESULTS
Fifteen studies including 40,061 patients were included. All the patients were from China or Germany. The TMAO level was significantly correlated with the Modified Rankin Score (mRS) 3 months after the onset of cerebral infarction (OR, 1.581; 95% CI, 1.259-1.987; < 0.01). The TMAO level was significantly correlated with the rate of first-time incidence and recurrence of cerebral infarction (OR, 1.208; 95% CI, 1.085-1.344; < 0.01 and HR, 1.167; 95% CI, 1.076-1.265; < 0.01, respectively). The TMAO level was also highly correlated with disease severity at onset (National Institutes of Health Stroke Scale, NIHSS >5) (OR, 5.194; 95% CI, 1.206-22.363; 0.05), but had no significant correlation with mortality after cerebral infarction ( > 0.05). Correlation analysis of TMAO with underlying diseases in the population indicated that TMAO had a significant correlation with histories of hypertension, diabetes mellitus, coronary artery disease, and cerebral infarction ( < 0.05), but not with hyperlipidemia ( > 0.05). Six risk prediction models of TMAO for cerebral infarction reported in four studies were systematically evaluated; five of them had good predictive value (AUC ≥ 0.7).
CONCLUSION
TMAO is an independent risk factor affecting the onset, prognosis, and severity of cerebral infarction.
目的
本研究旨在评估氧化三甲胺（TMAO）对脑梗死发病率及预后的影响。
方法
我们检索了PubMed、Embase和Cochrane数据库，以查找从数据库建立至2023年4月所有关于TMAO与脑梗死发病率及预后相关性的临床研究。使用流行病学观察性研究的Meta分析（MOOSE）声明列表进行系统评价和Meta分析。采用纽卡斯尔-渥太华量表（NOS）评估研究质量。本研究方案已在PROSPERO数据库注册，注册号为：CRD42023459661。提取的数据包括TMAO对脑梗死发病率及预后影响的OR值、TMAO与基础疾病之间的HR值、RR值、95%置信区间以及TMAO在脑梗死预测模型中的AUC值。
结果
纳入15项研究，共40,061例患者。所有患者均来自中国或德国。脑梗死发病3个月后的TMAO水平与改良Rankin量表评分（mRS）显著相关（OR = 1.581；95% CI：1.259 - 1.987；P < 0.01）。TMAO水平与脑梗死首次发病及复发率显著相关（OR = 1.208；95% CI：1.085 - 1.344；P < 0.01；HR = 1.167；95% CI：1.076 - 1.265；P < 0.01）。TMAO水平还与发病时的疾病严重程度（美国国立卫生研究院卒中量表，NIHSS > 5）高度相关（OR = 5.194；95% CI：1.206 - 22.363；P = 0.05），但与脑梗死死亡率无显著相关性（P > 0.05）。对人群中TMAO与基础疾病的相关性分析表明，TMAO与高血压、糖尿病、冠状动脉疾病和脑梗死病史显著相关（P < 0.05），但与高脂血症无显著相关性（P > 0.05）。对四项研究中报道的六种TMAO对脑梗死的风险预测模型进行了系统评价；其中五种具有良好的预测价值（AUC≥0.7）。
结论
TMAO是影响脑梗死发病、预后及严重程度的独立危险因素。
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