Correlation Study Between Serum Trimethylamine-N-Oxide And Large Artery Atherosclerosis Stroke

Objective To study the correlation between serum Trimethylamine-N-Oxide(TMAO)and the onset,severity,and clinical outcome of large atherosclerotic stroke(LAA).To analyze the correlation between TMAO and vulnerability of carotid artery atherosclerotic plaques in LAA patients.Method The 105 LAA cases in Department of Neurology of Inner Mongolia People’s Hospital from November 2020 to November 2021 were enrolled including 80 men and25 women with an average age of 65.57±9.05 years old.Serum TMAO levels were measured within 48 hours of the onset.The NIHSS score,thrombus astogram,and carotid artery color doppler ultrasound were conducted.Also,the relevant clinical and laboratory data were collected.The 120 cases healthy cases in the Medical Examination Center of Inner Mongolia People’s Hospital during the same period were enrolled including 86 men and 34 women with an average age of 62.51±9.98 years old.According to the vulnerability of carotid artery atherosclerotic plaques,LAA patients were divided into the stable plaques group and the instable plaques group.According to the mRS score after 90 days of the onset of LAA,LAA patients were divided into the good outcome group and the poor outcome group.The relationships between serum TMAO levels and the onset of LAA,NIHSS score and vulnerability of carotid artery atherosclerotic plaques were assessed.The correlation between serum TMAO and the mRS score after 90 days of the onset of LAA was evaluated using a prospective cohort study design.The correlations between serum TMAO and the onset of LAA,severity,clinical outcome,and vulnerability of carotid artery atherosclerotic plaques were studied using Binary Logistic regression analyses.Result1.Serum TMAO levels of LAA patients: TMAO level of the study group was4.38±0.88umol/L higher than that of the control group with 3.16±0.68umol/L(P<0.001).Logistic regression analysis showed that OR value was 41.59 and 95% CI was 1.83-942.77(P=0.019).These results suggested that a high serum TMAO level maybe a risk factor for the onset of LAA.Furthermore,the sensitivity and specificity were 72.4% and 90%,respectively,when the optimal cut-off value of the onset of LAA was 4.11umol/L.2.TMAO and NIHSS score of LAA patients on admission: Pearson correlation analysis showed that the correlation coefficient r was 0.6(P <0.001).This result indicated that the TMAO level was positively correlated with the NIHSS score in LAA patients on admission.3.TMAO and vulnerability of carotid artery atherosclerotic plaques in LAA patients: the serum TMAO level of the instable plaques group was 4.74±0.86umol/L higher than that of the stable plaque group with 4.07±0.76umol/L(P <0.001).Logistic regression analysis showed that the OR value was 4.436 and 95% CI was 2.041-9.642(P <0.001).These results suggested that a high TMAO level maybe a risk factor for the vulnerability of carotid artery atherosclerotic plaques in LAA patients.The sensitivity and specificity were 71.4% and 82.1%,respectively,when the optimal cutoff value of TMAO prediction of internal carotid atherosclerotic plaque vulnerability was4.47umol/L.4.TMAO and 90-day mRS score of LAA patients: the serum TMAO level of the good outcome group was 4.20±0.72umol/L with 86 cases and that of the poor outcome group was 5.22±1.05umol/L with 19 cases.Pearson correlation analysis showed that the correlation coefficient r was 0.63(P <0.001).These results indicated that the TMAO level on admission was positively correlated with 90-day mRS score of LAA patients.Logistic regression analysis showed that OR value was 4.81 and 95% CI was 1.89-12.23(P=0.001).These results suggested that a high serum TMAO level maybe a risk factor for 90-day poor prognosis of LAA patients.Conclusion1.Increased serum TMAO levels were an independent risk factor for the onset of LAA,and were positively correlated with LAA severity.2.Increased serum TMAO levels of LAA patients on admission were an independent risk factor for 90-day poor prognosis.3.The serum TMAO level in LAA patients was positively correlated with vulnerability of carotid artery atherosclerotic plaques.Increased serum TMAO levels were an independent risk factor for the higher vulnerability of carotid artery atherosclerotic plaques.