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 the plasma level of trimethylamine N-oxide 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（AMI）患者住院期间并发症之间的关系。方法入选2014年1月至2015年12月入住我院AMI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）分为单纯心肌梗死组（n=42）和心肌梗死并发症组（n=158）;根据入院时TMAO水平四分位分为4组,每组50例。比较各组的临床资料。应用Logistic回归计算不同TMAO水平并发症发生风险的比值比。Spearman秩相关分析比较TMAO与心肌肌钙蛋白Ⅰ（cTnⅠ）、N末端脑钠肽前体（NT-proBNP）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）。AMI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、左心室舒张末期内径、左心室射血分数、NT-proBNP、cTnⅠ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cTnⅠ、NT-proBNP和hsCRP的相关性强弱顺序为：cTnⅠ、NT-proBNP、hs-CRP（秩相关系数分别为0.72、0.64、0.42,均P〈0.05）。结论血浆TMAO水平与AMI患者住院期间并发症风险及血浆cTnⅠ、NT-proBNP、hs-CRP水平密切相关。

Aim To investigate the relationship between plasma level of trimethylamine N-oxide（ TMAO） and complication risk during hospitalization of patients with acute myocardial infarction（ AMI）. Methods 200 cases of AMI patients admitted in our hospital from January 2014 to December 2015 were enrolled in this study. According to whether there were complications（ new-onset symptomatic heart failure,arrhythmia,cardiogenic shock） during hospitalization,the patients were divided into simple myocardial infarction group（ n = 42） and myocardial infarction complication group（ n = 158）. According to TMAO level quartile at admission,the patients were divided into four groups,50 cases in each group. The clinical data were compared in various group. Odds ratio of complication risk at different TMAO levels was calculated by using Logistic regression. Correlations between TMAO and cardiac troponin Ⅰ（ cTnⅠ）,N-terminal proB-type natriuretic peptide（ NT-proBNP） and high-sensitivity C-reactive protein（ hs-CRP） were compared by Spearman rank correlation analysis. Results TMAO level in the myocardial infarction complication group was significantly higher than that in the simple myocardial infarction group（ 6.4±1.8 μmol/L vs 4.2±1.3 μmol/L,P〈0.05）. There was a positive correlation between the TMAO level and the risk of complication in patients with AMI. After adjusting age,diabetes,estimated glomerular filtration rate,left ventricular end-diastolic diameter,left ventricular ejection fraction,NT-proBNP,cTnⅠ and hs-CRP,the risk of complications in patients with TMAO level of highest quartile was 6.01 times that in patients with TMAO level of lowest quartile（ 95% CI 2. 03-17. 73,P〈0. 05）. The size order of correlation between TMAO and cTnⅠ,NT-proBNP and hs-CRP was as follows： cTnⅠ,NT-proBNP,hs-CRP（ rank correlation coefficient was 0. 72,0. 64 and0.42,respectively,all P〈0. 05）. Conclusion Plasma TMAO level is closely related to the risk of complications during hospitalization and the plasma levels of cTnⅠ,NT-proBNP and hs-CRP in patients with AMI.