Trimethylamine N-Oxide and Stroke Recurrence Depends on Ischemic Stroke Subtypes
Trimethylamine N-Oxide and Stroke Recurrence Depends on Ischemic Stroke Subtypes
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三甲胺 N-氧化物和中风复发取决于缺血性中风亚型
DOI：
10.1161/strokeaha.120.031443
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发表时间：
2022-04-01
期刊：
影响因子：
8.3
通讯作者：
Wang, Yongjun
中科院分区：
文献类型：
--
作者：
Xu, Jie;Cheng, Aichun;Wang, Yongjun
背景：氧化三甲胺（TMAO）已被认为是心血管疾病的危险因素。然而，TMAO在缺血性卒中中的作用仍不清楚。众所周知，缺血性脑卒中是一种异质性疾病，其发病机制多种多样。因此，我们的目的是调查之间的联系TMAO和中风复发的病因亚型。研究方法：纳入第三次全国脑卒中登记中心的10 756例缺血性脑卒中/短暂性脑缺血发作患者，分析1年随访的脑卒中复发情况。采用吐司（Trial of ORG 10172 in Acute Stroke Treatment）标准对病因亚型进行分类。通过液相色谱-质谱法定量血浆TMAO水平。使用考克斯回归模型分析TMAO与卒中结局之间的关联。我们还对TMAO水平与中风风险的关联进行了荟萃分析。结果如下：在多变量考克斯回归模型中，TMAO水平升高与卒中复发风险独立相关（Q4 vs Q1：校正风险比，1.37 [95% CI，1.15-1.64]）。在按吐司亚型分层后，在小动脉闭塞亚型中，TMAO与卒中复发显著相关（校正的风险比，1.43 [95% CI，1.03-2.00]），但在其他亚型中不存在（大动脉粥样硬化，1.19 [0.95-1.48];心源性栓塞，1.54 [0.95-2.48];其他，1.19 [0.98-1.44]）。荟萃分析报告了最高与最低TMAO水平的卒中复发，合并风险比为1.66（95% CI，0.91-3.01），同样发现卒中复发风险增加。结论：在小动脉闭塞亚型患者中，TMAO水平升高与卒中复发风险增加相关，但在大动脉粥样硬化、心源性栓塞和其他亚型患者中，这种相关性似乎减弱。
Background: Trimethylamine N-oxide (TMAO) has been recognized as a risk factor for cardiovascular disease. However, the role of TMAO in ischemic stroke remains unclear. As we know, ischemic stroke is a heterogeneous disease with variable pathogenesis. Hence, we aimed to investigate the association between TMAO and stroke recurrence according to etiology subtypes. Methods: A total of 10 756 ischemic stroke/transient ischemic attack patients from the Third China National Stroke Registry were enrolled, and 1-year follow-up data for stroke recurrence were analyzed. TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria was used to classify the etiology subtypes. Plasma TMAO levels were quantified by liquid chromatography–mass spectrometry. The association between TMAO and stroke outcomes was analyzed using Cox regression models. We also conducted a meta-analysis on the association of TMAO levels and stroke risk. Results: Elevated TMAO level was independently associated with the risk of stroke recurrence (Q4 versus Q1: adjusted hazard ratio, 1.37 [95% CI, 1.15–1.64]) in multivariate Cox regression model. After stratification by TOAST subtypes, there was a significant association between TMAO and stroke recurrence in small artery occlusion subtype (adjusted hazard ratio, 1.43 [95% CI, 1.03–2.00]) but not in the others subtype (large-artery atherosclerosis, 1.19 [0.95–1.48]; cardioembolism, 1.54 [0.95–2.48]; others, 1.19 [0.98–1.44]). The meta-analysis reported on stroke recurrence for the highest versus lowest TMAO levels with a pooled hazard ratio of 1.66 (95% CI, 0.91–3.01) and similarly found an increased risk of stroke recurrence. Conclusions: Elevated TMAO level is associated with increased risk of stroke recurrence in patients with small artery occlusion subtype, but this association seems to be attenuated in large-artery atherosclerosis, cardioembolism, and others subtypes.