肠道菌群代谢产物与冠心病合并慢性心力衰竭的相关性及对患者预后水平的预测作用

杨晓明; 郑祥; 王超超

doi:10.16766/j.cnki.issn.1674-4152.003198

肠道菌群代谢产物与冠心病合并慢性心力衰竭的相关性及对患者预后水平的预测作用

doi: 10.16766/j.cnki.issn.1674-4152.003198

1.
温州市中西医结合医院心血管内科，浙江温州 325000
2.
温州市中西医结合医院肾内科

基金项目:

浙江省卫生健康科技计划项目 2022KY1208

详细信息

通讯作者:
郑祥，E-mail：kinddoctorky@126.com

中图分类号: R37 R541.4
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- 文章访问数: 141
- HTML全文浏览量: 70
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-21
- 网络出版日期: 2023-11-23

Correlation between gut microbiota metabolites and coronary heart disease combined with chronic heart failure and its predictive role in patient prognosis

1.
Department of Cardiovascular Medicine, Wenzhou Integrated Traditional Chinese and Western Medicine Hospital, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨肠道菌群代谢物氧化三甲胺(TMAO)和苯乙酰谷氨酰胺(PAGln)与稳定性冠心病(SCAD)合并慢性心力衰竭(CHF)患者心功能指标的相关性，分析其联合预测SCAD合并CHF患者主要不良心血管事件(MACE)的临床价值。方法选取2018年4月—2021年4月温州市中西医结合医院心血管内科门诊收治的200例SCAD合并CHF和200例单纯SCAD患者为研究对象，分析SCAD合并CHF患者TMAO和PAGln含量与心功能指标的相关性，评估TMAO联合PAGln预测MACE的诊断效能。结果 SCAD合并CHF患者左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、基质金属蛋白酶-9(MMP-9)、脑钠肽(BNP)、TMAO和PAGln均高于单纯SCAD患者，而左室射血分数(LVEF)和脂联素(APN)均低于单纯SCAD患者(均P < 0.05)。SCAD合并CHF患者TMAO和PAGln与LVESD、LVEDD、MMP-9和BNP均呈正相关关系(均P < 0.05)，而与LVEF和APN均呈负相关关系(均P < 0.05)。出现MACE的SCAD合并CHF患者血清TMAO和PAGln均高于非MACE患者(均P < 0.05)。TMAO联合PAGln预测SCAD合并CHF患者MACE的ROC曲线下面积、灵敏度和特异度分别为0.964、91.20%和93.70%，均高于两者单独预测。结论 SCAD合并CHF患者肠道菌群代谢物TMAO和PAGln含量均呈现升高趋势，两者联合预测SCAD合并CHF患者MACE具有较高的临床价值。
- 肠道菌群 /
- 代谢物 /
- 氧化三甲胺 /
- 苯乙酰谷氨酰胺 /
- 稳定性冠心病 /
- 慢性心力衰竭 /
- 预后
Abstract: Objective To explore of the correlation between intestinal microbiota metabolites trimethylamine oxide (TMAO) and phenylacetylglutamine (PAGln) and cardiac function indicators in patients with stable coronary heart disease (SCAD) and chronic heart failure (CHF), and analyze the clinical value of their combined use in predicting major adverse cardiovascular events (MACE) in patients with SCAD and CHF. Methods A total of 200 patients with SCAD combined with CHF and 200 patients with SCAD alone admitted to the Cardiovascular Department of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from April 2018 to April 2021 were selected as the study subjects. The correlation between the contents of TMAO and PAGln and cardiac function indexes in SCAD patients with CHF were analyzed. The diagnostic efficacy of TMAO combined with PAGln in predicting MACE were analyzed. Results The left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), matrix metalloproteinase-9 (MMP-9), brain natriuretic peptide (BNP), TMAO, and PAGln values in patients with SCAD combined with CHF were significantly higher than those in simple SCAD patient, while left ventricular ejection fraction (LVEF) and adiponectin (APN) values were significantly lower than those in patients with simple SCAD (all P < 0.05). TMAO and PAGln in patients with SCAD combined with CHF were positively correlated with LVESD, LVEDD, MMP-9, and BNP detection values (all P < 0.05), while they were negatively correlated with LVEF and APN detection values (all P < 0.05). Serum TMAO and PAGln levels in SCAD patients with MACE combined with CHF were significantly higher than those in non-MACE patients (all P < 0.05). TMAO combined with PAGln predicted the area, sensitivity and specificity under the receiver operating characteristic of MACE in patients with SCAD and CHF (0.964, 91.20% and 93.70%), which were higher than those predicted by both alone. Conclusion The levels of intestinal microbiota metabolites TMAO and PAGln in SCAD combined with CHF patients show an increasing trend, and the combination of the two has high clinical value in predicting MACE in SCAD combined with CHF patients.
- Intestinal microbiota /
- Metabolites /
- Trimethylamine oxide /
- Phenylacetylglutamine /
- Stable coronary heart disease /
- Chronic heart failure /
- Prognosis

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图 1 TMAO和PAGln预测SCAD合并CHF患者MACE的ROC曲线

Figure 1. ROC curves for MACE in SCAD patients with concomitant CHF using TMAO and PAGln

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表 1 SCAD合并CHF与单纯SCAD患者心功能指标及肠道菌群代谢物含量比较(x±s)

Table 1. Comparison of cardiac functional parameters and gut microbial metabolite levels between patients with SCAD and concurrent CHF, and patients with isolated SCAD (x±s)

组别	例数	LVEF (%)	LVESD (mm)	LVEDD (mm)	APN (μg/mL)	MMP-9 (μg/mL)	BNP (μg/mL)	TMAO (μmol/L)	PAGln (ng/mL)
SCAD合并CHF组	200	41.82±3.62	42.96±4.01	55.73±4.73	9.27±1.13	174.16±16.21	526.39±42.85	7.19±0.70	176.52±16.23
单纯SCAD组	200	45.53±3.74	38.75±3.82	51.29±4.46	10.84±1.26	156.82±14.63	451.64±40.73	5.83±0.64	148.74±14.56
t值		10.080	10.750	9.659	13.119	11.231	17.881	20.278	18.018
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 2 SCAD合并CHF患者TMAO和PAGln与心功能指标相关性分析

Table 2. Correlation analysis of TMAO and PAGln with cardiac functional parameters in patients with SCAD and concurrent CHF

心功能超声指标	TMAO		PAGln
心功能超声指标	r值	P值	r值	P值
LVEF	-0.852	＜0.001	-0.864	＜0.001
LVESD	0.743	0.024	0.751	0.021
LVEDD	0.762	0.011	0.773	0.009
APN	-0.771	0.008	-0.782	0.005
MMP-9	0.816	＜0.001	0.824	＜0.001
BNP	0.831	＜0.001	0.856	＜0.001

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表 3 不同预后SCAD合并CHF患者TMAO和PAGln含量比较(x±s)

Table 3. Comparison of TMAO and PAGln levels in SCAD patients with concurrent CHF of different prognosis (x±s)

组别	例数	TMAO(μmol/L)	PAGln(ng/mL)
MACE组	57	7.89±0.63	182.84±8.92
非MACE组	143	6.91±0.50	167.72±7.33
t值		11.573	12.354
P值		＜0.001	＜0.001

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表 4 TMAO和PAGln预测SCAD合并CHF患者MACE的诊断效能

Table 4. The diagnostic performance of TMAO and PAGln in predicting MACE in patients with SCAD and CHF

检测指标	ROC曲线下面积	灵敏度(%)	特异度(%)	95% CI
TMAO	0.894	82.50	84.60	0.843~0.944
PAGln	0.916	89.50	80.40	0.879~0.953
TMAO联合PAGln	0.964	91.20	93.70	0.938~0.989

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