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血浆氧化三甲胺与冠心病的相关性及对冠心病患者预后的影响

Correlation between plasma trimethylamine-N-oxide and coronary heart disease and its effect on the prognosis of patients with coronary heart disease

    摘要
  • 摘要:
    目的 探讨氧化三甲胺（TMAO）与冠心病（CHD）相关性以及对CHD患者预后的影响。
    方法 选取2019年5月—2020年12月行冠状动脉造影的CHD患者200例（CHD组），另选取冠状动脉造影或冠状动脉CT结果阴性的健康者124例（对照组）。采用高效液相色谱串联质谱法（HPLC-MS/MS）测定TMAO水平，根据所测血浆TMAO数值中位数3.14 μmol/L将CHD组分为A组（低TMAO CHD组）与B组（高TMAO CHD组）。采用Gensini评分对患者的冠状动脉病变程度进行评定。分析对照组与CHD组TMAO水平，以及冠状动脉病变程度与TMAO水平相关性。将CHD的影响因素及TMAO的影响因素进行Logistic回归分析。记录随访CHD患者1年内出现的死亡、心肌梗死、再次血运重建等不良事件，绘制Kaplan-Meier生存和风险曲线，进一步比较A组、B组不良事件发生率。
    结果 CHD组TMAO水平高于对照组，差异有统计学意义（P=0.001）。高TMAO水平是CHD的危险因素（OR=7.54，95%CI：4.27~13.33，P < 0.001）；在CHD患者中，体质量指数（BMI）高是TMAO升高的危险因素（OR=1.48，95%CI：1.09~2.00，P=0.001）。A组患者Gensini评分低于B组患者，差异有统计学意义（P < 0.05）。CHD患者血清TMAO水平与Gensini评分呈正相关（r=-0.449，P < 0.001）。A组、B组生存曲线比较，差异有统计学意义（P=0.005）。B组生存率下降，风险率上升。
    结论 TMAO是CHD的影响因素之一，且CHD患者病变严重程度、心血管不良事件与TMAO水平有关。TMAO可以作为CHD诊断和预后评估的标志物。

     

    Abstract:
    Objective To investigate the correlation between trimethylamine-N-oxide (TMAO) and coronary heart disease (CHD) and its impact on the prognosis of patients with CHD.
    Methods From May 2019 to December 2020, 200 CHD patients who underwent coronary angiography (CHD group) and 124 healthy subjects with negative coronary angiography or coronary CT results (control group) were selected. The level of TMAO was determined by high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). According to the median plasma TMAO value of 3.14 μmol/L, the CHD group was divided into group A(low TMAO CHD group) and group B (high TMAO CHD group). Gensini score was used to evaluate the degree of coronary artery disease. The levels of TMAO in the control group and CHD group were analyzed, and the correlation between the degree of coronary artery disease and TMAO level was analyzed. The influencing factors of CHD and TMAO were analyzed by logistic regression. Patients with CHD were followed up for 1 year, death, myocardial infarction, revascularization and other adverse events were recorded. Kaplan-Meier survival and risk curves were drawn to further compare the incidence of adverse events between the group A and group B.
    Results The level of TMAO in the CHD group was significantly higher than that in the control group (P=0.001). High TMAO level was a risk factor for CHD (OR=7.54, 95%CI, 4.27 to 13.33, P < 0.001); in patients with CHD, high body mass index (BMI) was a risk factor for elevated TMAO (OR=1.48, 95%CI, 1.09 to 2.00, P=0.001). The Gensini score of the group A was significantly lower than that of the group B (P < 0.05). Serum TMAO level in CHD patients was positively correlated with Gensini score (r=-0.449, P < 0.001). There was a significant difference in survival curve between the group A and group B (P=0.005). In group B, the survival rate decreased and the hazard rate increased.
    Conclusion TMAO is one of the influencing factors for CHD, and the severity of lesions and cardiovascular adverse events in CHD patients are related to TMAO level. TMAO can be used as a diagnostic and prognostic marker for CHD.

     

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