循环总对甲酚硫酸盐和吲哚硫酸浓度与稳定型冠状动脉疾病患者中心性肥胖的相关性：性别特异性分析。
Associations of circulating total p-cresylsulfate and indoxyl sulfate concentrations with central obesity in patients with stable coronary artery disease: sex-specific insights.
机构信息
Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan.
School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan.
出版信息
Int J Obes (Lond). 2024 Dec;48(12):1775-1784. doi: 10.1038/s41366-024-01624-1. Epub 2024 Sep 5.
BACKGROUND/AIMS: Elevated systemic inflammation, common in obesity, increases cardiovascular disease risk. Obesity is linked to a pro-inflammatory gut microbiota that releases uremic toxins like p-cresylsulfate (PCS) and indoxyl sulfate (IS), which are implicated in coronary atherosclerosis, insulin resistance, and chronic kidney disease. This study examines the relationship between total PCS and IS levels and central obesity in patients with stable coronary artery disease (CAD).
METHODS
A cross-sectional study was conducted on 373 consecutive patients with stable CAD from a single center. Serum levels of total PCS and IS were measured using an Ultra Performance LC System. Central obesity was evaluated using a body shape index (ABSI) and conicity index (CI). Six obesity-related proteins were also analyzed. Structural equation modeling (SEM) assessed direct and indirect effects of total PCS, IS, and the six obesity-related proteins on central obesity.
RESULTS
Significant positive correlations were found between total PCS and IS with waist-to-hip ratio (WHR) (r = 0.174, p = 0.005 for total PCS; r = 0.144, p = 0.021 for IS), CI (r = 0.273, p < 0.0001 for total PCS; r = 0.260, p < 0.0001 for IS), and ABSI (r = 0.297, p < 0.0001 for total PCS; r = 0.285, p < 0.0001 for IS) in male patients, but not in female patients. Multivariate analysis showed higher odds ratios (ORs) for elevated CI (OR = 3.18, 95% CI: 1.54-6.75, p = 0.002) and ABSI (OR = 3.28, 95% CI: 1.54-7.24, p = 0.002) in patients with high PCS levels, and elevated CI (OR = 2.30, 95% CI: 1.15-4.66, p = 0.018) and ABSI (OR = 2.22, 95% CI: 1.07-4.72, p = 0.033) in those with high IS levels, compared to those with low toxin levels. SEM analysis indicated that total PCS and IS directly impacted central obesity indices and indirectly influenced central adiposity measures like WHR through high sensitivity C-reactive protein (hs-CRP) (β = 0.252, p < 0.001).
CONCLUSIONS
Circulating total PCS and IS contribute to central obesity in male patients with stable CAD, partially mediated by hs-CRP.
背景/目的：全身性炎症在肥胖症中很常见，会增加心血管疾病的风险。肥胖与促炎的肠道微生物群有关，肠道微生物群会释放尿毒症毒素，如对甲酚硫酸盐（PCS）和吲哚硫酸盐（IS），这些毒素与冠状动脉粥样硬化、胰岛素抵抗和慢性肾病有关。本研究旨在探讨稳定型冠状动脉疾病（CAD）患者血清总 PCS 和 IS 水平与中心性肥胖之间的关系。
方法
对来自单一中心的 373 例稳定型 CAD 连续患者进行了一项横断面研究。使用超高效 LC 系统测量血清总 PCS 和 IS 水平。使用体脂指数（ABSI）和锥度指数（CI）评估中心性肥胖。还分析了 6 种肥胖相关蛋白。结构方程模型（SEM）评估了总 PCS、IS 和 6 种肥胖相关蛋白对中心性肥胖的直接和间接影响。
结果
在男性患者中，总 PCS 和 IS 与腰臀比（WHR）（总 PCS：r=0.174，p=0.005；IS：r=0.144，p=0.021）、CI（总 PCS：r=0.273，p<0.0001；IS：r=0.260，p<0.0001）和 ABSI（总 PCS：r=0.297，p<0.0001；IS：r=0.285，p<0.0001）呈显著正相关，但在女性患者中无此相关性。多变量分析显示，高 PCS 水平患者的 CI（OR=3.18，95%CI：1.54-6.75，p=0.002）和 ABSI（OR=3.28，95%CI：1.54-7.24，p=0.002）升高的比值比（OR）较高，而 IS 水平升高的患者的 CI（OR=2.30，95%CI：1.15-4.66，p=0.018）和 ABSI（OR=2.22，95%CI：1.07-4.72，p=0.033）升高。结构方程模型分析表明，总 PCS 和 IS 直接影响中心性肥胖指数，通过高敏 C 反应蛋白（hs-CRP）间接影响 WHR 等中心性肥胖指标（β=0.252，p<0.001）。
结论
在稳定型 CAD 男性患者中，循环总 PCS 和 IS 导致中心性肥胖，部分通过 hs-CRP 介导。
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