肠道菌群代谢产物氧化三甲胺与STEMI患者PCI术后2年心血管事件发生风险的相关性

何明; 何超杰; 刘金涛; 胡艳艳; 朱泳金

doi:10.16766/j.cnki.issn.1674-4152.004126

肠道菌群代谢产物氧化三甲胺与STEMI患者PCI术后2年心血管事件发生风险的相关性

doi: 10.16766/j.cnki.issn.1674-4152.004126

1.
嘉兴市中医医院心内科，浙江嘉兴 314000
2.
嘉兴大学附属第一医院心内科，浙江嘉兴 314000

基金项目:

浙江省基础公益计划项目 LQ23H020001

详细信息

通讯作者:
何明，E-mail：heming18157333806

中图分类号: R542.22 R654.2
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- 文章访问数: 10
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- 被引次数: 0
出版历程
- 收稿日期: 2025-01-08
- 网络出版日期: 2025-10-31

Association between intestinal flora metabolite trimethylamine oxide and 2-year cardiovascular event risk in STEMI Patients after PCI

1.
Department of Cardiology, Jiaxing Traditional Chinese Medicine Hospital, Jiaxing, Zhejiang 314000, China

摘要

摘要: 目的肠道菌群代谢产物氧化三甲胺(TMAO)已被证实与心血管疾病(CVD)发生紧密相关，本研究进一步探讨TMAO与急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后2年心血管事件(MACE)发生风险的相关性。方法前瞻性选取2021年6月—2022年12月在嘉兴市中医医院成功接受PCI治疗的158例STEMI患者(STEMI组)。PCI术后2年随访期发生MACE者和未发生MACE者分别为MACE组、No-MACE组。另选取40例健康体检者为对照组。比较不同组间血浆TMAO水平，采用logistic逐步分析法和绘制ROC曲线分析血浆TMAO与STEMI组PCI术后2年MACE发生的关系。结果 STEMI组血浆TMAO[4.81(4.12，7.48)μmol/Lvs. 2.25(1.48，2.60)μmol/L]高于对照组(Z=14.057，P＜0.001)。MACE组、No-MACE组分别为48、102例，MACE组年龄、糖尿病史、血清可溶性生长刺激表达因子2(sST2)、N末端脑利钠肽前体(NT-proBNP)、TMAO均高于No-MACE组(P＜0.05)。糖尿病史和较高的年龄、sST2、TMAO是STEMI组PCI术后2年MACE发生的独立危险因素(P＜0.05)，TMAO的预测截断值为5.13 μmol/L，且曲线下面积(AUC)高于sST2(P＜0.05)。结论 STEMI患者血浆TMAO水平异常升高，且较高水平TMAO者有更高的MACE发生风险，血浆TMAO水平对PCI术后2年MACE有较好的预测价值。
- 急性ST段抬高型心肌梗死 /
- 氧化三甲胺 /
- 经皮冠状动脉介入术 /
- 心血管事件
Abstract: Objective Trimethylamine oxide (TMAO), a metabolite of intestinal flora, has been shown to be closely associated with the occurrence of cardiovascular disease (CVD). This study further investigated the association between TMAO and major adverse cardiovascular events (MACE) at 2 years after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 158 STEMI patients who successfully underwent PCI treatment at Jiaxing Hospital of Traditional Chinese Medicine from June 2021 to December 2022 were prospectively selected and recorded (STEMI group). During the 2-year follow-up period after PCI, those with MACE and those without MACE were respectively classified as the MACE group and the No-MACE group. Another 40 healthy volunteers of the same age were selected and recorded as the control group. The plasma TMAO level was compared between different groups, and the relationship between plasma TMAO and MACE occurrence 2 years after PCI in STEMI group was analyzed by logistic stepwise analysis and ROC curve. Results Plasma TMAO [4.81 (4.12, 7.48) μmol/L vs. 2.25 (1.48, 2.60) μmol/L] in STEMI group was higher than that in control group (Z=14.057, P<0.001). There were 48 cases in the MACE group and 102 cases in the No-MACE group, respectively. Age, diabetes history, serum soluble growth stimulation expression factor 2 (sST2), N-terminal brain natriuretic peptide precursor (NT-proBNP) and TMAO in MACE group were higher than those in No-MACE group, and the differences were statistically significant (P<0.05). After modifying the collinearity of independent variables, stepwise logistic analysis showed that diabetes history and higher age, sST2, TMAO were independent risk factors for MACE 2 years after PCI in STEMI group (P<0.05). The predicted cutoff value of TMAO was 5.13 μmol/L, and the area under the curve (AUC) was higher than that of sST2 (P<0.05). Conclusion The plasma TMAO level of STEMI patients is abnormally elevated, and those with a higher level of TMAO have a higher risk of MACE occurrence. The plasma TMAO level has a good predictive value for MACE 2 years after PCI.
- Acute ST-segment elevation myocardial infarction /
- Trimethylamine oxide /
- Percutaneous coronary intervention /
- Cardiovascular event

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图 1 TMAO、sST2、NT-proBNP预测STEMI患者PCI术后2年MACE的ROC曲线

Figure 1. ROC curves of TMAO, sST2, and NT-adjuvant proBNP for predicting MACE in STEMI patients 2 years after PCI

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表 1 MACE组和No-MACE组人口学和临床资料比较

Table 1. Comparison of demographic and clinical data between the MACE group and the No-MACE group

组别	例数	性别 (男/女，例)	年龄 (x±s，岁)	BMI (x±s)	糖尿病 [例(%)]	高血压 [例(%)]	高脂血症 [例(%)]	吸烟 [例(%)]	Killip分级 (Ⅰ~Ⅱ/Ⅲ~Ⅳ级，例)
MACE组	48	30/18	66.53±6.94	24.67±2.38	18(37.50)	19(39.58)	10(20.83)	20(41.67)	27/21
No-MACE组	102	57/45	63.40±7.01	24.58±2.43	21(20.59)	36(35.29)	17(16.67)	34(33.33)	62/40
统计量		0.587^a	2.559^b	0.213^b	4.852^a	0.259^a	0.384^a	0.984^a	0.278^a
P值		0.444	0.012	0.832	0.028	0.611	0.536	0.321	0.598

组别	例数	发病至PCI时间 (x±s，h)	罪犯血管 (LAD/LCX/RA，例)		置入支架数 (＜2/≥2个，例)	LVEF (x±s，%)	sST2 (x±s，ng/mL)	NT-proBNP (x±s，pg/mL)	TMAO [M(P₂₅, P₇₅)，μmol/L]
MACE组	48	6.73±1.39	20/18/10		30/18	48.95±4.09	67.31±13.20	1 193.08±310.46	6.23(5.16，7.80)
No-MACE组	102	6.70±1.40	49/33/20		62/40	50.12±4.10	46.97±10.83	786.13±253.58	4.46(4.01，5.12)
统计量		0.123^b	0.567^a		0.041^a	1.632^b	9.005^b	8.519^b	5.081^c
P值		0.903	0.753		0.840	0.105	＜0.001	＜0.001	＜0.001
注：^a为χ²值，^b为t值, ^c为Z值。

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表 2 STEMI患者PCI术后2年MACE发生的影响因素logistic分析

Table 2. Logistic analysis of factors influencing MACE occurrence in STEMI patients 2 years after PCI

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.710	0.325	4.773	0.006	2.034	1.312~4.036
糖尿病史	0.437	0.209	4.372	0.013	1.548	1.087~2.351
sST2	0.591	0.237	6.218	＜0.001	1.806	1.176~3.248
TMAO	0.664	0.261	6.472	＜0.001	1.942	1.307~4.516

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表 3 TMAO对STEMI患者PCI术后2年MACE的预测效能

Table 3. The predictive efficacy of TMAO for MACE in STEMI patients 2 years after PCI

变量	AUC	标准误	截断值	P值	95% CI
TMAO	0.872	0.043	5.13 μmol/L	＜0.001	0.794~0.950
sST2	0.795	0.059	54.26 ng/mL	＜0.001	0.703~0.887
NT-proBNP	0.826	0.053	956.48 pg/mL	＜0.001	0.725~0.937

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