摘要
目的:探讨血清氧化三甲胺(TMAO)水平与冠心病(CHD)及冠状动脉狭窄程度的相关性。方法:选取行冠状动脉造影(CAG)诊治的病人390例,其中CHD组285例,包括急性冠状动脉综合征(ACS)组173例、慢性冠状动脉综合征(CCS)组112例;经CAG排除CHD的病人105例为对照组。其中ACS病人分为ST段抬高型心肌梗死(STEMI)组、非ST段抬高型心肌梗死(NSTEMI)组、不稳定性心绞痛(UAP)组三个亚组;按照Gensini评分标准将CHD病人分为轻度狭窄组、中度狭窄组、重度狭窄组。采用酶联免疫吸附试验(ELISA)测定血清TMAO水平,比较各组一般资料及血清TMAO水平。结果:3组年龄、性别、身高、体质量、体质量指数、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、肌酐、尿素氮、血糖、糖尿病史比较差异均无统计学意义(P>0.05)。与对照组比较,ACS组和CCS组病人患高血压比例、吸烟比例、脂蛋白磷脂酶A2(Lp-PLA2)、脑钠肽(BNP)、TMAO水平明显升高(P<0.01),且ACS组病人总胆固醇(TC)、白细胞介素6(IL-6)、超敏C反应蛋白(hs-CRP)水平明显高于对照组(P<0.05~P<0.01)。与CCS组比较,ACS组TC、IL-6、hs-CRP、Lp-PLA2、TMAO水平明显高于CCS组(P<0.01)。ACS 3个亚组间血清TMAO水平比较差异无统计学意义(P>0.05)。logistic回归分析显示TMAO、TC、Lp-PLA2、吸烟、高血压均是CHD的独立危险因素(P<0.05~P<0.01);ROC曲线分析结果显示血清TMAO诊断CHD的最佳临界值为13.80μmol/L时,AUC为0.702,敏感度和特异度分别为73.70%和62.90%;TMAO+IL-6+Lp-PLA2+hs-CRP四者联合的AUC为0.792,敏感度和特异度分别为71.60%、74.30%。中度和重度狭窄组TMAO水平均显著高于轻度组,重度组显著高于中度组(P<0.01)。结论:CHD病人血清TMAO水平较高,且ACS病人高于CCS病人,是CHD的独立危险因素,可作为CHD诊断和评估冠状动脉狭窄程度的潜在性指标。
Objective:To investigate the correlation of serum trimethylamine N-oxide(TMAO)level and coronary heart disease(CHD)and the degree of coronary artery stenosis.Methods:A total of 390 patients who underwent coronary angiography(CAG)were selected,including 285 cases in the CHD group,173 cases in the acute coronary syndrome(ACS)group and 112 cases in the chronic coronary syndrome(CCS)group.Another 105 patients with CHD excluded by CAG were included in the control group.ACS patients was divided into three subgroups:ST-segment elevation myocardial infarction(STEMI)group,non-ST-segment elevation myocardial infarction(NSTEMI)group and unstable angina pectoris(UAP)group.According to Gensini scoring criteria,CHD patients were divided into mild stenosis group,moderate stenosis group and severe stenosis group.Serum TMAO level was measured by enzyme-linked immunosorbent assay(ELISA),and the general information and serum TMAO level were compared among the groups.Results:There were no significant differences in age,gender,height,weight,body mass index,triacylglycerol(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),creatinine,urea nitrogen,blood glucose and history of diabetes mellitus among the three groups(P>0.05).Compared with the control group,the proportion of hypertension,the proportion of smoking,the levels of LP-PLA2,BNP and TMAO in the ACS group and CCS group were significantly increased(P<0.01),and the levels of TC,IL-6 and hs-CRP in the ACS group were significantly higher than those in the control group(P<0.05 to P<0.01).Compared with the CCS group,the levels of TC,IL-6,hs-CRP,LP-PLA2 and TMAO in the ACS group were significantly higher(P<0.01).There was no significant difference in serum TMAO level among the three groups(P>0.05).Logistic regression analysis showed that TMAO,TC,LP-PLA2,smoking and hypertension were independent risk factors for CHD(P<0.05 to P<0.01).ROC curve analysis showed that the optimal cut-off value of serum TMAO for diagnosing CHD was 13.80μmol/L,AUC was
作者
邢团结
娄焕堃
李鹏
梅佳慧
王勋
韩翠敏
王怡练
孙黎明
XING Tuan-jie;LOU Huan-kun;LI Peng;MEI Jia-hui;WANG Xun;HAN Cui-min;WANG Yi-lian;SUN Li-ming(Department of Cardiovascular Medicine,Lianyungang Second People′s Hospital Affiliated to Bengbu Medical College,Lianyungang Jiangsu 222006,China)
出处
《蚌埠医学院学报》
CAS
2023年第4期466-469,473,共5页
Journal of Bengbu Medical College
基金
江苏省“六大人才高峰”资助项目(2015-WSN-098)
江苏省连云港市科技局社会发展项目(SH1537)。
关键词
冠心病
氧化三甲胺
动脉粥样硬化
冠状动脉综合征
coronary heart disease
trimethylamine N-oxide
atherosclerosis
coronary syndrome
