Plasma Trimethylamine N-Oxide, a Gut Microbe-Generated Phosphatidylcholine Metabolite, Is Associated With Atherosclerotic Burden.
Plasma Trimethylamine N-Oxide, a Gut Microbe-Generated Phosphatidylcholine Metabolite, Is Associated With Atherosclerotic Burden.
复制标题
DOI：
10.1016/j.jacc.2016.03.546
复制
发表时间：
2016-06-07
影响因子：
24
通讯作者：
Tang WH
中科院分区：
文献类型：
--
作者：
Senthong V;Li XS;Hudec T;Coughlin J;Wu Y;Levison B;Wang Z;Hazen SL;Tang WH
三甲胺N-氧化物（TMAO）是一种来自膳食磷脂酰胆碱的肠道微生物群代谢产物，与动脉粥样硬化性冠状动脉疾病（CAD）发病机制有关，并与不良结局相关。我们研究了血浆TMAO水平与CAD的复杂性和负担以及亚临床肌坏死程度之间的关系。我们研究了2012年至2014年期间在择期冠状动脉造影中检测到动脉粥样硬化性CAD证据的353例连续稳定患者，这些患者测量了高敏心肌肌钙蛋白T（hs-cTnT）。SYNTAX（紫杉醇PCI和心脏手术之间的协同作用）评分和病变特征用于量化动脉粥样硬化负荷。通过质谱法测量空腹血浆TMAO。在这项前瞻性队列研究中，中位TMAO水平为5.5 μM（四分位距[IQR]：3.4 - 9.8 μM）;中位SYNTAX评分为11.0（IQR：4.0 - 18.5）; 289例（81.9%）、40例（11.3%）和24例（6.8%）患者的SYNTAX评分分别为低（0 - 22）、中等（23 - 32）和高（≥33）。血浆TMAO水平与SYNTAX评分（r = 0.61）、SYNTAX评分II（r = 0.62）和hs-cTnT（r = 0.29）相关（均p < 0.0001）。调整传统的危险因素，体重指数，药物，病变特征，肾功能和高敏C反应蛋白，TMAO水平升高仍然与较高的SYNTAX评分独立相关（比值比[OR]：4.82; p < 0.0001），SYNTAX评分II（OR：1.88; p = 0.0002），但与亚临床肌坏死无关（OR：1.14; p = 0.3147）。TMAO水平升高是弥漫性病变存在的独立预测因子，即使在调整传统风险因素和hs-cTnT后也是如此（OR：2.05; 95%置信区间：1.45 - 2.9; p = 0.0001）。空腹血浆TMAO水平是CAD患者高动脉粥样硬化负荷的独立预测因子。
Trimethylamine N-oxide (TMAO), a gut microbiota metabolite from dietary phosphatidylcholine, has mechanistic links to atherosclerotic coronary artery disease (CAD) pathogenesis and is associated with adverse outcomes. We examined the relationship between plasma TMAO levels and the complexity and burden of CAD and degree of subclinical myonecrosis. We studied 353 consecutive stable patients with evidence of atherosclerotic CAD detected on elective coronary angiography between 2012 and 2014 who had high-sensitivity cardiac troponin T (hs-cTnT) measured. SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores and lesion characteristics were used to quantify atherosclerotic burden. Fasting plasma TMAO was measured by mass spectrometry. In this prospective cohort study, median TMAO level was 5.5 μM (interquartile range [IQR]: 3.4 to 9.8 μM); median SYNTAX score was 11.0 (IQR: 4.0 to 18.5); and 289 (81.9%), 40 (11.3%) and 24 (6.8%) patients had low (0 to 22), intermediate (23 to 32), and high (≥33) SYNTAX scores, respectively. Plasma TMAO levels correlated (all p < 0.0001) with SYNTAX score (r = 0.61), SYNTAX score II (r = 0.62), and hs-cTnT (r = 0.29). Adjusting for traditional risk factors, body mass index, medications, lesion characteristic, renal function, and high-sensitivity C-reactive protein, elevated TMAO levels remained independently associated with a higher SYNTAX score (odds ratio [OR]: 4.82; p < 0.0001), SYNTAX score II (OR: 1.88; p = 0.0002) but not with subclinical myonecrosis (OR: 1.14; p = 0.3147). Elevated TMAO level was an independent predictor of the presence of diffuse lesions, even following adjustments for traditional risk factors and hs-cTnT (OR: 2.05; 95% confidence interval: 1.45 to 2.9; p = 0.0001). Fasting plasma TMAO levels are an independent predictor for high atherosclerotic burden in patients with CAD.