血浆氧化三甲胺水平与罪犯斑块易损特征的相关性  

The association of plasma trimethylamine N-oxide with characteristics of culprit plaque

作　　者：盛兆雪 谭宇[1] 周鹏[1] 刘臣[1] 李健楠[1] 周金英[1] 陈润真 陈艺 宋莉[1] 赵汉军[1] 颜红兵[1] SHENG Zhao-xue;TAN Yu;ZHOU Peng;LIU Chen;LI Jian-nan;ZHOU Jin-ying;CHEN Run-zhen;CHEN Yi;SONG Li;ZHAO Han-jun;YAN Hong-bing(State Key Laboratory of Cardiovascular Disease,National Centerfor Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union MedicalCollege,Beijing 100037,China)

机构地区：[1]国家心血管病中心北京协和医学院中国医学科学院阜外医院冠心病中心,北京100037

出　　处：《中国介入心脏病学杂志》2019年第5期271-275,共5页Chinese Journal of Interventional Cardiology

基　　金：中国医学科学院医学与健康科技创新工程基金(2016-I2M-1-009;NCT03593928)

摘　　要：目的探讨急性心肌梗死斑块破裂人群血浆氧化三甲胺(TMAO)水平与罪犯斑块易损特征的关系。方法连续入选中国医学科学院阜外医院2017年4月1日至2018年7月31日因急性心肌梗死行直接经皮冠状动脉介入治疗并行光学相干断层成像(OCT)检查后证实斑块破裂的90例患者。搜集患者人口学资料、危险因素、既往病史、围术期实验室检查结果、冠状动脉造影资料和OCT影像特征资料。使用稳定同位素稀释-高效液相色谱-串联质谱法测定患者的血浆TMAO水平,根据TMAO中位数(3.22μmol/L)水平将入选患者分为TMAO高值组(45例)和TMAO低值组(45例)。使用归一化标准差(NSD)定量评估罪犯斑块巨噬细胞浸润程度。结果与TMAO低值组患者相比,TMAO高值组患者最小纤维帽厚度更薄[60.00(60.00,100.00)μm比90.00(70.00,110.00)μm,P=0.013],而薄纤维帽斑块比例(55.6%比15.6%,P<0.001)、微通道比例(24.4%比4.4%,P=0.014)和巨噬细胞浸润比例(66.7%比26.7%,P<0.001)更高。TMAO水平与反映罪犯斑块巨噬细胞浸润程度的NSD呈显著正相关(Pearson’s r=0.542,P<0.001)。结论在由斑块破裂导致急性心肌梗死患者中血浆TMAO与罪犯斑块的易损性相关。TMAO可以作为反映冠状动脉斑块易损性的潜在生物标志物,从而优化急性心肌梗死患者危险分层方法和临床治疗策略。Objective To explore the relation between plasma trimethylamine N-oxide (TMAO) and coronary culprit plaque characterization assessed by OCT in AMI patients exhibiting plaque rupture. Methods We consecutively enrolled 90 patients with AMI undergoing primary percutaneous coronary intervention and exhibiting plaque rupture at the site of the culprit stenosis identifi ed by OCT from April 1, 2017 to July 31, 2018. Demographic data, risk factors, procedural and OCT data, previous medical history and perioperative laboratory fi ndings were collected in all patients. Plasma TMAO levels were detected by stable isotope dilution liquid chromatography tandem mass spectrometry, and the patients were divided into two groups, high TMAO group and low TMAO group with 45 cases in each, based on the median of TMAO (3.22 μmol/L). Macrophage presence in coronary culprit plaque was quantifi ed by normalized standard deviation (NSD). Results The culprit plaques in the high TMAO group exhibited a thinner fi brous cap thickness [60.00 (60.00, 100.00)μm vs. 90.00 (70.00, 110.00)μm, P=0.013], higher frequency of thin-cap fibroatheroma (55.6% vs. 15.6%, P<0.001), microvessel (24.4% vs. 4.4%, P=0.014) and macrophage infi ltration (66.7% vs. 26.7%, P<0.001) compared with the low TMAO group. Moreover, the level of TMAO was signifi cantly positively associated with NSD (Pearson’s r=0.542, P<0.001). Conclusions Plasma TMAO is associated with coronary plaque vulnerability in patients with AMI exhibiting plaque rupture. TMAO can be used as a potential biomarker to refl ect the coronary plaque vulnerability to optimize risk stratifi cation and clinical treatment strategies in AMI patients.

关 键 词：急性心肌梗死 光学相干断层成像 斑块破裂 氧化三甲胺 

分 类 号：R541.4[医药卫生—心血管疾病]