肠道菌群代谢产物氧化三甲胺与缺血性脑卒中关系的研究进展

Research progress in the relationship between gut microbiota metabolite trimethylamine N-oxide and ischemic stroke

缺血性脑卒中(ischemic stroke,IS)是一类严重危害人类健康的脑血管疾病。肠道菌群作为中间介质在大脑与肠道之间起到双向调节的关键作用。近年来,氧化三甲胺(trimethylamine N-oxide,TMAO)作为肠道菌群代谢产物在心血管疾病中受到广泛关注。高TMAO水平可能通过影响IS的危险因素如动脉粥样硬化、心房颤动、高血压和2型糖尿病增加IS发生风险。TMAO加剧IS患者神经功能的损伤,增加IS复发风险,而且是患者卒中后认知障碍(post-stroke cognitive impairment,PSCI)的独立预测因素。目前的研究认为,TMAO的作用机制包括损伤血管内皮功能、促进泡沫细胞形成、影响胆固醇代谢和增强血小板反应性等。通过中药、饮食管理、维生素和益生菌的合理应用等治疗方式降低血浆TMAO水平,可预防和治疗IS。

Ischemic stroke(IS)is a severe cerebrovascular disease that seriously endangers human health.Gut microbiota plays a key role as an intermediate mediator in bidirectional regulation between the brain and the intestine.In recent years,trimethylamine N-oxide(TMAO)as a gut microbiota metabolite has received widespread attention in cardiovascular diseases.Elevated levels of TMAO may increase the risk of IS by affecting IS risk factors such as atherosclerosis,atrial fibrillation,hypertension,and type 2 diabetes.TMAO exacerbates neurological damage in IS patients,increases the risk of IS recurrence,and is an independent predictor of post-stroke cognitive impairment(PSCI)in patients.Current research suggests that the mechanisms of TMAO action include endothelial dysfunction,promoting of foam cell formation,influence on cholesterol metabolism,and enhancement of platelet reactivity.Lowering plasma TMAO levels through the rational use of traditional Chinese medicine,dietary management,vitamins,and probiotics can prevent and treat IS.