Yang Hsiao-Hui, Chen Yen-Cheng, Liu Chin-Hung, Hsu Bang-Gee
Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Med Sci Monit. 2025 Feb 4;31:e947197. doi: 10.12659/MSM.947197.
BACKGROUND Trimethylamine N-oxide (TMAO), a gut-derived uremic toxin, is linked to hypertension, cardiovascular events, and mortality. Peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), increases mortality in kidney transplantation (KT) recipients. This study investigated the association between serum TMAO levels and PAD in KT recipients. MATERIAL AND METHODS This cross-sectional study included 98 KT recipients. Serum TMAO levels were quantified using liquid chromatography-mass spectrometry, and ABI values were assessed with an automated oscillometric device. Patients with ABI <0.9 were categorized as having PAD. Additional clinical and laboratory data were collected from medical records for analysis. RESULTS Among 98 KT recipients, 22 (22.4%) had low ABI values. The low-ABI group had higher serum TMAO levels (P<0.001) and a higher diabetes prevalence (P=0.035). In multivariate analysis, serum TMAO levels were independently associated with PAD (odds ratio: 1.154, 95% CI: 1.062-1.255, P=0.001). Both the left and right ABI values were negatively correlated with TMAO levels (P<0.001). In the Spearman correlation analysis, the estimated glomerular filtration rate (eGFR) was negatively correlated with TMAO levels (P=0.005). The area under the receiver operating characteristic curve for TMAO predicting PAD was 0.868 (95% CI: 0.784-0.928, P<0.001). CONCLUSIONS Elevated serum TMAO levels are independently associated with PAD in KT recipients, as evidenced by their significant negative correlation with ABI values. These findings suggest that TMAO may serve as a potential biomarker for identifying KT recipients at higher risk of PAD.
背景 氧化三甲胺（TMAO）是一种源自肠道的尿毒症毒素，与高血压、心血管事件及死亡率相关。外周动脉疾病（PAD）以低踝臂指数（ABI）为定义，会增加肾移植（KT）受者的死亡率。本研究调查了KT受者血清TMAO水平与PAD之间的关联。
材料与方法 这项横断面研究纳入了98名KT受者。采用液相色谱 - 质谱法定量血清TMAO水平，并用自动示波装置评估ABI值。ABI<0.9的患者被归类为患有PAD。从病历中收集额外的临床和实验室数据进行分析。
结果 在98名KT受者中，22名（22.4%）ABI值较低。低ABI组血清TMAO水平较高（P<0.001）且糖尿病患病率较高（P = 0.035）。在多变量分析中，血清TMAO水平与PAD独立相关（优势比：1.154，95%置信区间：1.062 - 1.255，P = 0.001）。左右ABI值均与TMAO水平呈负相关（P<0.001）。在Spearman相关性分析中，估计肾小球滤过率（eGFR）与TMAO水平呈负相关（P = 0.005）。TMAO预测PAD的受试者工作特征曲线下面积为0.868（95%置信区间：0.784 - 0.928，P<0.001）。
结论 血清TMAO水平升高与KT受者的PAD独立相关，这通过它们与ABI值的显著负相关得以证明。这些发现表明TMAO可能作为一种潜在的生物标志物，用于识别PAD风险较高的KT受者。
