Elevated trimethylamine N-oxide related to ischemic brain lesions after carotid artery stenting
Elevated trimethylamine N-oxide related to ischemic brain lesions after carotid artery stenting
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三甲胺 N-氧化物升高与颈动脉支架置入术后缺血性脑损伤相关
DOI：
10.1212/wnl.0000000000005298
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发表时间：
2018-04-10
期刊：
影响因子：
9.9
通讯作者：
Ji, Xunming
中科院分区：
文献类型：
--
作者：
Wu, Chuanjie;Li, Chuanhui;Ji, Xunming
目的探讨动脉粥样硬化性肠道微生物区系代谢产物三甲胺N氧化物(TMAO)水平能否作为颈动脉支架置入术(CAS)后缺血性脑损伤的预测指标。方法在这项多中心的前瞻性队列研究中，我们招募了接受CAS治疗的颈动脉重度狭窄患者(70%)。于CAS前3d内测定血浆TMAO水平，并于CAS后1~3d行MRI检查。结果268例患者的平均年龄为64.4岁。弥散加权成像(DWI)发现117例(43.7%)新病灶。有新病变的患者血清TMAO水平高于无新病变的患者(中位数5.2vs3.2微克分子/L；p<；0.001)。血浆TMAO水平升高与冠脉造影后新病变的风险增加相关(调整后最高和最低四分位的优势比为3.85；95%可信区间为1.37-7.56，p<；0.001；调整后的第三和最低四分位的优势比为1.86；95%可信区间为1.09-4.66，p=0.02)。TMAO的受试者工作特征曲线下面积为0.706，最佳临界值为4.29µm ol/L，≥4.29µm o l/L预测新病变的敏感性、特异性、阳性预测值和阴性预测值分别为61.5%、74.8%、65.5%和65.5%。结论TMAO水平升高与CAS术后MRI显示的新的缺血性脑损伤的风险增加有关。
Objectives To investigate whether the plasma level of trimethylamine N-oxide (TMAO), a proatherosclerotic intestinal microbiota metabolite, can be a predictor of ischemic brain injury secondary to carotid artery stenting (CAS). Methods In this multicenter, prospective cohort study, we enrolled patients with severe carotid artery stenosis (>70%) who were prepared for CAS. Plasma TMAO level was measured within 3 days before CAS, and MRI was performed 1 to 3 days after CAS. Results The mean age of the 268 eligible patients was 64.4 years. New lesions on diffusion-weighted imaging (DWI) were detected in 117 patients (43.7%). TMAO level was higher in patients with new (DWI) lesions than in patients without new lesions (median 5.2 vs 3.2 µmol/L; p < 0.001). Increased plasma TMAO levels were associated with an increased risk of having new lesions on DWI after CAS (adjusted odds ratio for the highest vs lowest quartile, 3.85; 95% confidence interval, 1.37–7.56, p < 0.001; adjusted odds ratio for the third vs lowest quartile, 1.86; 95% confidence interval, 1.09–4.66, p = 0.02). The area under the receiver operating characteristic curve of TMAO was 0.706 for new lesions on DWI, and the optimal cutoff value was 4.29 µmol/L. The sensitivity, specificity, positive predictive value, and negative predictive value of TMAO levels ≥4.29 µmol/L for predicting new lesions on DWI were 61.5%, 74.8%, 65.5%, and 65.5%, respectively. Conclusions Increased TMAO levels are associated with an increased risk of new ischemic brain lesions on post-CAS MRI scans.