冠心病合并脑血管狭窄与血浆氧化三甲胺水平的关系

Association Between Plasm Trimethylamine-N-oxide Level and Coronary Artery Disease Patients Complicating With Cerebrovascular Stenosis

目的:探讨冠心病合并脑血管狭窄与血浆氧化三甲胺(TMAO)的关系。方法:回顾性分析了2013年10月至2016年6月于首都医科大学附属北京天坛医院心内科就诊的158例住院患者。患者均在住院期间接受了冠状动脉造影及全脑血管造影,并依据检查结果分为:对照组(无冠心病及脑血管狭窄病变,n=20)、冠心病组(n=25)、脑血管狭窄组(n=17)和冠心病合并脑血管狭窄组(n=96)。检测并比较各组空腹血浆TMAO及其前体物质左旋肉碱、胆碱、甜菜碱等水平,分别比较冠心病组、冠心病合并脑血管狭窄组Gensini评分与TMAO的相关性。结果:冠心病组与冠心病合并脑血管狭窄组中位TMAO水平分别为7.15(3.77,16.75)μmol、8.13(4.87,17.38)μmol,均明显高于对照组的3.22(2.19,9.00)μmol,P均<0.001;将各组TAMO水平经自然对数转化为正态分布后比较显示,冠心病组与冠心病合并脑血管狭窄组仍高于对照组(P均<0.01),也高于脑血管狭窄组(P均<0.05),不过冠心病组与冠心病合并脑血管狭窄组差异未见统计学意义(P=0.682);脑血管狭窄组与对照组差异未见统计学意义(P=0.582)。各组间左旋肉碱、胆碱、甜菜碱血浆水平差异未见统计学意义(P>0.05)。在冠心病组,TMAO水平与Gensini评分正相关(r=0.569,P=0.009),左旋肉碱水平与Gensini评分负相关(r=-0.700,P=0.001),胆碱、甜菜碱水平与Gensini评分未见明显相关;在冠心病合并脑血管狭窄组,TMAO、左旋肉碱、胆碱、甜菜碱血浆水平均未见与Gensini评分明显相关。结论:冠心病合并脑血管狭窄与血浆TMAO水平升高无关。

Objectives:To investigate the association between plasm trimethylamine-N-oxide(TMAO)level and coronary artery disease(CAD)patients concomitant with cerebrovascular stenosis(CVS).Methods:A total of 158 consecutive patients who synchronously undertook coronary angiography and total cerebral angiography in Beijing Tiantan Hospital between October 2013 and June 2016 were included in this retrospective study.Patients were divided into the control group(without CAD and cerebrovascular stenosis,n=20),CAD group(n=25),CVS group(n=17),concomitant CAD and CVS group(n=96).We detected and compared the levels of TMAO and its precursors including L-Carnitine,choline and betaine among the groups.The correlation between Gensini scores and TMAO were analyzed in either CAD group or concomitant CAD and CVS group(CAD+CVS group).Results:The levels of TMAO in both CAD group(7.15[3.77,16.75]μmol)and CAD+CVS group(8.13[4.87,17.38]μmol)were higher than those in the control group(3.22[2.19,9.00]μmol,both P<0.001).The levels of TMAO(after natural logarithm transformation)in both CAD group and CAD+CVS group were higher than those in the control group(all P<0.01).Plasma TMAO level was significantly higher in CAD group than in CVS group(P=0.019).TMAO level was similar between the control group and CVS group(P=0.582).Moreover,TMAO level was higher in CAD+CVS group than in CVS group(P=0.002),similar between CAD+CVS group and CAD group(P=0.682).Additionally,the levels of L-carnitine,choline or betaine were similar among the groups(P>0.05)。Meanwhile,Gensini score was positively associated with TMAO(r=0.569,P=0.009)and negatively with L-carnitine(r=-0.700,P=0.001)in CAD group,whereas there was no correlation between Gensini scores and L-Carnitine,choline and betaine in CAD+CVS group.Conclusions:Concomitant cerebrovascular stenosis may be not associated with an increased plasm TMAO concentration in patients with coronary artery disease.