血浆氧化三甲胺检测对急性心肌梗死患者心室重构及预后的评估价值

Evaluation value of plasma trimethylamine oxide determination for ventricular remodeling and prognosis in patients with acute myocardial infarction

目的探讨血浆氧化三甲胺(TMAO)检测对急性心肌梗死患者心室重构及预后的评估价值。方法选择103例急性心肌梗死患者为病例组、60例体检健康者为对照组。采用高效液相色谱串联质谱法检测血浆TMAO;超声心动图检测心室重构参数,并与血浆TMAO做相关分析;记录患者经皮冠状动脉介入(PCI)术后6个月内发生的不良心血管事件,用受试者工作特征曲线下面积(AUC)评估TAMO对预后的预测价值。结果病例组血浆TMAO水平高于对照组(P <0. 001)。病例组左心房内径(LAD)、左心室后壁厚度(LVPWT)、左心室后壁舒张末期厚度(PWD)、左心室后壁收缩末期厚度(PWS)、左室心肌质量指数(LVMI)大于对照组(P均<0. 05),左心室射血分数(LVEF)低于对照组(P <0. 05)。血浆TMAO水平与LAD、LVPWT、PWD、PWS、LVMI呈正相关(r分别为0. 532、0. 463、0. 491、0. 486、0. 569,P均<0. 05),与LVEF呈负相关(r=-0. 519,P <0. 05)。PCI术后6个月,发生不良心血管事件17例(16. 50%)。TMAO评估急性心肌梗死患者PCI术后6个月预后的AUC为0. 877,95%CI为0. 806～0. 947,此时TMAO最佳截断值为5. 08μmol/L,灵敏度、特异度分别为0. 76、0. 89,准确度为0. 85。结论急性心肌梗死患者血浆TMAO水平升高,早期对其进行检测有助于评估患者心室重构程度、预测预后。

Objective To investigate the evaluation value of plasma trimethylamine oxide(TMAO)determination for ventricular remodeling and prognosis in patients with acute myocardial infarction(AMI).Methods Totally 103 AMI patients were selected as the case group and 60 healthy persons as the control group.The plasma TMAO was measured by high performance liquid chromatography tandem mass spectrometry,ventricular remodeling parameter was examined by echocardiography,and the correlation analysis between ventricular remodeling parameter and plasma TMAO was performed.Adverse cardiovascular event within 6 months after percutaneous coronary intervention was recorded.The predictive value of TAMO for prognosis was assessed by area under curve(AUC)of receiver operating characteristic curve(ROC).Results Plasma TMAO level in the case group was higher than that in the control group(P<0.001).Left atrial diameter(LAD),left ventricular posterior wall thickness(LVPWT),left ventricular posterior wall end-diastolic thickness(PWD),left ventricular posterior wall end-systolic thickness(PWS),left ventricular mass index(LVMI)were higher in the case group than in the control group(all P<0.05),and left ventricular ejection fraction(LVEF)was lower than that in the control group(P<0.05).The plasma TMAO level was positively correlated with LAD,LVPWT,PWD,PWS,and LVMI(r=0.532,0.463,0.491,0.486,and 0.569,all P<0.05),and negatively correlated with LVEF(r=-0.519,P<0.05).Seventeen(16.50%)cases of adverse cardiovascular events occurred at 6 months after PCI.The AUC of TMAO in evaluating the prognosis of patients with AMI at 6 months after PCI was 0.877,95%CI was 0.806-0.947.At this time,the optimal truncation value of TMAO was 5.08μmol/L.The sensitivity and specificity were 0.76 and 0.89,respectively,and the accuracy was 0.85.Conclusions The plasma TMAO level in AMI patients is elevated.Early detection of TMAO contributes to the assessment of ventricular remodeling and the prediction of prognosis.