Elevated Serum Trimethylamine N-Oxide Levels Are Associated with Mortality in Male Patients on Peritoneal Dialysis
Elevated Serum Trimethylamine N-Oxide Levels Are Associated with Mortality in Male Patients on Peritoneal Dialysis
复制标题
血清三甲胺 N-氧化物水平升高与腹膜透析男性患者的死亡率相关
DOI：
10.1159/000512962
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发表时间：
2021-02-17
影响因子：
3
通讯作者：
Mao, Haiping
中科院分区：
文献类型：
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作者：
Fu, Dongying;Shen, Jiani;Mao, Haiping
背景：血液透析患者血清三甲胺N-氧化物(TMAO)水平升高与心血管不良(CV)和全因死亡有关。然而，腹膜透析(PD)患者血清TMAO水平的临床意义尚不清楚。方法：1,032名血清样本储存在基线水平的PD患者参加了这项前瞻性研究。采用超高效液相色谱-串联质谱法测定血清中TMAO浓度。使用COX比例风险和竞争风险回归模型来检验TMAO水平与全因和心血管病死率之间的关系。结果：本研究人群血清TMAO水平中位数为34.5(四分位数范围19.8~61.0)MU。在中位随访时间为63.7个月(IQR 43.9~87.2)期间，245例(24%)患者死亡，其中129例(53%)死于心血管疾病。在整个队列中，我们观察到血清氧化三甲胺水平升高与全因死亡率之间存在关联(调整后的亚分布危险比[SHR]，1.22；95%可信区间[95%CI]，1.01-1.48；p=0.039)，但与心血管死亡率无关。进一步的分析显示，这种关联因性别而异；血清TMAO水平的升高与男性全因风险(自发性高血压1.37%，95%可信区间1.07-1.76；p=0.013)和心血管死亡率(自发性高血压1.41；95%可信区间1.02-1.94；p=0.038)独立相关，但与女性无关。结论：在接受PD治疗的男性患者中，较高的血清TMAO水平与全因死亡率和心血管病死率独立相关。
Background: Elevated levels of serum trimethylamine N-oxide (TMAO) have been previously linked to adverse cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the clinical significance of serum TMAO levels in patients treated with peritoneal dialysis (PD) is unclear. Methods: A total of 1,032 PD patients with stored serum samples at baseline were enrolled in this prospective study. Serum concentrations of TMAO were quantified by ultra-performance liquid chromatography-tandem mass spectrometry. Cox proportional hazards and competing-risk regression models were performed to examine the association of TMAO levels with all-cause and CV mortality. Results: The median level of serum TMAO in our study population was 34.5 (interquartile range (IQR), 19.8-61.0) mu M. During a median follow-up of 63.7 months (IQR, 43.9-87.2), 245 (24%) patients died, with 129 (53%) deaths resulting from CV disease. In the entire cohort, we observed an association between elevated serum TMAO levels and all-cause mortality (adjusted subdistributional hazard ratio [SHR], 1.22; 95% confidence interval [95% CI], 1.01-1.48; p = 0.039) but not CV mortality. Further analysis revealed such association differed by sex; the elevation of serum TMAO levels was independently associated with increased risk of both all-cause (SHR, 1.37; 95% CI, 1.07-1.76; p = 0.013) and CV mortality (SHR, 1.41; 95% CI, 1.02-1.94; p = 0.038) in men but not in women. Conclusions: Higher serum TMAO levels were independently associated with all-cause and CV mortality in male patients treated with PD.