血清中氧化三甲胺对老年急性缺血性脑卒中预后的预测价值

The predictive value of serum trimethylamine N-oxide on the prognosis of elderly patients with acute ischemic stroke

目的检测急性缺血性脑卒中老年患者血清中TMAO水平,探究其与患者预后的关系及其对脑卒中预后预测模型的价值。方法回顾分析2018年10月-2019年7月就诊复旦大学附属闵行医院神经内科的急性缺血性脑卒中老年患者(发病24h内)73例,收集并检测其入院时血清TMAO及常规生物学指标,根据NIHSS和mRS评估患者入院时病情及发病后3个月预后随访结果,将患者分为预后良好组(mRS 0~2分)和预后不良组(mRS 3~6分),进一步分析血清TMAO水平与预后的相关性以及纳入该指标对预测模型的影响。结果73例老年患者中,共有13例患者预后不良,占18%。TMAO浓度范围是0.63~6.89μmol/L,中位值为2.48μmol/L,其预测不良预后的最佳截断值为2.38μmol/L,ROC曲线下面积为0.74,灵敏度为0.92,特异度为0.57。将TMAO纳入基础预测模型后,能够提高模型的预测效率,模型ROC曲线下面积由0.67(95%CI0.53~0.81)上升为0.87(95%CI0.79~0.95),重分类改善指标(NRI)为42.2%,综合判别改善指数(IDI)为24.7%;将TMAO纳入THRIVE模型后,曲线下面积由0.72(95%CI0.59~0.85)增加为0.90(95%CI0.83~0.97),NRI为48.9%,IDI为24.7%,模型预测能力改善。结论急性期血清TMAO水平越高,脑卒中预后越差;TMAO作为一项与动脉粥样硬化相关的新型生物标记物,纳入该指标可有效改善脑卒中预测模型的预测能力,具有潜在的临床应用价值。

Objective To detect the serum trimethylamine N-oxide(TMAO)level in elderly patients with acute ischemic stroke and explore its relationship with the prognosis of patients and its value in predicting the prognosis of stroke.Methods The data of 73 elderly patients with acute ischemic stroke(within 24 hours of onset)who visited the Department of Neurology,Minhang Hospital Affiliated to Fudan University from October 2018 to July 2019 were retrospective analyzed.The levels of serum TMAO and other common biological indexes of patients were collected and detected at admission.According to the NIHSS and mRS assessment of the patient’s condition at admission and the prognostic follow-up results 3 months after the onset,the patients were divided into the good prognosis group(mRS 0-2 points)and poor prognosis group(mRS 3-6 points).The correlation between serum TMAO level and prognosis was further analyzed,as well as the influence of this index on the prediction model.Results Among 73 elderly patients,13 ones had poor prognosis,accounting for 18%.The concentration range of TMAO was 0.63~6.89μmol/L,the median value was 2.48μmol/L,the best cut-off value for predicting poor prognosis was 2.38μmol/L,the area under the ROC curve was 0.74,the sensitivity was 0.92,and the specificity was 0.57.When TMAO was incorporated into the basic prediction model,the prediction efficiency of the model was improved.The area under the ROC curve of the model increased from 0.67(95%CI 0.53-0.81)to 0.87(95%CI 0.79-0.95),and the net reclassification improvement index(NRI)was 42.2%,the Integrated discrimination improvement(IDI)was 24.7%.When TMAO was incorporated into the THRIVE model,the area under the curve increased from 0.72(95%CI 0.59~0.85)to 0.90(95%CI 0.83~0.97),NRI was 48.9%,IDI was 24.7%,and the predictive ability of the model improved.Conclusion The higher the serum TMAO level in the acute phase,the worse the prognosis of stroke.As a new biomarker related to atherosclerosis,TMAO can effectively improve the predictive ability of stroke prediction models and has potential clinical application value.