血浆氧化三甲胺水平与急性心肌梗死患者并发症的关系

Relationship between plasma trimethylamine-N-oxide levels and complication risk in patients with acute myocardial infarction

目的探讨血浆氧化三甲胺(TMAO)水平与急性心肌梗死患者住院期间并发症之间的关系。方法入选2014年1月~2015年12月入住莆田学院附属医院心血管内科急性心肌梗死患者200例,根据住院期间有无发生并发症(新发症状性心力衰竭、心律失常、心源性休克)分为心肌梗死并发症组(n=158)和单纯心肌梗死组(n=42);根据入院时TMAO水平四分位分组(≤2.43μmol/L,2.43~3.66μmol/L,3.67~6.18μmol/L和≥6.18μmol/L),应用Logistic回归计算不同TMAO水平并发症发生风险的比值比;Spearman等级相关分析TMAO与血浆N末端脑钠肽前体(NT-pro BNP)、心肌肌钙蛋白I(c Tn I)和高敏C反应蛋白(hs-CRP)的相关性。结果心肌梗死并发症组TMAO水平显著高于单纯心肌梗死组(6.4±1.8μmol/L比4.2±1.3μmol/L,P<0.05)。急性心肌梗死患者TMAO水平与并发症发生风险之间存在正相关,校正年龄、糖尿病、估算肾小球滤过率(e GFR)、左心室舒张期末内径(LVDd)、左心室射血分数(LVEF)、c Tn I、NT-pro BNP和hs-CRP以后,TMAO水平最高四分位数患者发生并发症的风险是最低四分位数患者的6.01倍(95%CI:2.03~17.73,P<0.05)。TMAO与血浆c Tn I、NT-pro BNP和hsCRP的相关性强弱顺序为:c Tn I>NT-pro BNP>hs-CRP(秩相关系数分别为0.64、0.62和0.38,P均<0.05)。结论血浆TMAO水平与急性心肌梗死患者住院期间并发症风险及血浆c Tn I、NT-pro BNP水平密切相关。

Aim To investigate the relationship between plasma trimethylamine N-oxide（TMAO） levels and complication risk in patients with acute myocardial infarction（AMI）. Methods 200 consecutive AMI patients admitted into Cardiology Department of Affiliated Hospital of Putian University from January 2014 to December 2015 were enrolled. Patients were categorized into complication group（n = 158） and non-complication group（n = 42） according to the presence or absence of new-onset symptomatic heart failure,arrhythmia or cardiac shock. Patients were divided into quartiles based on TMAO levels（≤2.43 μmol/L,2.43 ~ 3.66 μmol/L,3.67 ~ 6.18 μmol/L and ≥6.18 μmol/L,respectively）,and odds ratio（OR） of incident complication was calculated by using logistic regression. Correlation of TMAO with cardiac troponin I（c Tn I）,N-terminal pro-brain natriuretic peptide（NT-pro BNP） and high-sensitivity C-reactive protein（hs-CRP） were analysed by Spearman rank correlation analysis. Results TMAO levels in complication group were significantly higher than those in non-complication group（6.4±1.8 μmol/L vs 4.2±1.3 μmol/L,P〈0.05）. TMAO levels of AMI patients were positively associated with complication risk. After adjustment for age,diabetes,estimated glomerular filtration rate,left ventricular end-diastolic dimension,left ventricular ejection fraction,and plasma NT-pro BNP,c Tn I and hs-CRP levels,patients in the highest quartile of TMAO entailed 6. 01 times greater risk for complication than those in the lowest quartile of TMAO（95% confidence interval： 2.03~17.73,P〈0.05）. Correlation of TMAO levels with c Tn I was the strongest,followed by NTpro BNP and hs-CRP（rs= 0.64,0.62 and 0.38 respectively,all P〈0.05）. Conclusion Higher TMAO is associated with increased risk of AMI complication and elevated plasma c Tn I and NT-pro BNP levels.