黄芳 杨思聪 康观养 杨文聪

[摘要] 目的 探讨阿托伐他汀钙对慢性冠状动脉综合征患者血浆氧化三甲胺（TMAO）水平的影响。 方法 回顾性选取52例在中山大学附属第七医院心血管内科2020 年 10 月至2021年1月诊断为慢性冠状动脉综合征的患者，均使用阿托伐他汀钙（10 mg/d）治疗，比较治疗前及治疗1个月后的血脂指标（TG、CHOL、HDL-C、LDL-C）、空腹血糖（FPG）、肝功能指标（AST、ALT）、肾功能指标（BUN、Crea）、心功能指标（TnI、CK-MB）、炎症指标（CRP），并运用液质联用法（LC-MS）检测TMAO的水平变化。 结果 与治疗前相比，使用阿托伐他汀钙治疗后TG、CHOL、CRP以及TMAO水平明显下降（P<0.05）;Logistic回归分析显示，使用阿托伐他汀钙后会使TMAO及CHOL明显降低（P<0.05）;TMAO用于区分阿托伐他汀钙使用改善慢性冠状动脉综合征能力的ROC曲線下面积（AUC）为0.882，最佳截断点TMAO浓度为7.37 μmol/L时，敏感性（Sensitivity）为73.1%，特异性（Specificity）为90.4%;TMAO与生化指标中的TG呈正相关（rho值0.295，P<0.05）。 结论 TMAO水平与血脂密切相关，经阿托伐他汀钙治疗后可明显降低TMAO水平，提示其可能是阿托伐他汀钙改善慢性冠状动脉综合征患者症状的机制之一。

[关键词] 阿托伐他汀钙;慢性冠状动脉综合征;氧化三甲胺;血脂

[中图分类号] R541.61          [文献标识码] B          [文章编号] 1673-9701（2021）36-0037-04

Effect of atorvastatin calcium on plasma trimethylamine N-oxide levels in patients with chronic coronary syndromes

HUANG Fang1   YANG Sicong1   KANG Guanyang2   YANG Wencong1

1.Department of Cardiovascular Medicine， the Seventh Affiliated Hospital of Sun Yat-sen University， Shenzhen   518107， China; 2.Department of Cardiology， Binhaiwan Central Hospital of Dongguan City in Guangdong Province， Dongguan 523990， China

[Abstract] Objective To explore the effect of atorvastatin calcium on plasma trimethylamine n-oxide （TMAO） levels in patients with chronic coronary syndromes. Methods A total of 52 patients diagnosed with chronic coronary syndromes in Department of Cardiovascular Medicine of the Seventh Affiliated Hospital of Sun Yat-sen University from October 2020 to January 2021 were retrospectively selected as study subjects. All patients were treated with atorvastatin calcium （10 mg/d）， and blood was drawn to detect lipid indicators （triglyceride [TG]， total cholesterol [CHOL]， high-density lipoprotein cholesterol [HDL-C]， low-density lipoprotein cholesterol [LDL-C]）， fasting plasma glucose （FPG）， liver function indicators （aspartate aminotransferase [AST]， alanine aminotransferase [ALT]）， renal function indicators （blood urea nitrogen [BUN]， creatinine [Crea]）， cardiac function indicators （troponin I [TnI]， creatine kinase-MB [CK-MB]）， and inflammation indicators （C-reactive protein [CRP]） before and after one month of treatment. Meanwhile， changes in TMAO levels were detected by liquid chromatography-mass spectrometry （LC-MS）. Results After treatment with atorvastatin calcium， TG， CHOL， CRP， and TMAO levels were significantly lower than those before treatment （P<0.05）. The Logistic regression analysis showed that after treatment with atorvastatin calcium， TMAO and CHOL levels were significantly lowered （P<0.05）. The area under the curve （AUC） of receiver operating characteristic curve （ROC） for TMAO to differentiate the ability of atorvastatin calcium in improving chronic coronary syndromes was 0.882， and the optimal cut-off point was at a TMAO concentration of 7.37 μmol/L， with a sensitivity of 73.1% and specificity of 90.4%. TMAO level was positively correlated with TG level in biochemical indicators （rho=0.295， P<0.05）. Conclusion TMAO level is closely related to blood lipids， and the TMAO level can be significantly lowered by atorvastatin calcium， which may be one of the mechanisms by which atorvastatin calcium improves patients with chronic coronary syndromes.

[Key words] Atorvastatin calcium; Chronic coronary syndromes; Trimethylamine n-oxide; Blood lipids

冠状动脉粥样硬化是影响心血管健康的最主要问题，目前我国冠心病患病人数已达1100万人，是我国最重要的疾病负担之一[1]。国内外越来越多的研究显示，氧化三甲胺（Trimethylamine oxide，TMAO）是心血管疾病的独立危险因素，尤其是冠心病患者会出现TMAO升高，且与疾病的严重程度呈正相关[2]。研究显示，TMAO能够促进动脉粥样硬化的发生发展，并与发生冠状动脉粥样硬化性心脏病的不良心血管病事件风险相关[3]。……