The Study Of The Predictive Value Of Intestinal Metabolites On The Long-Term Prognosis Of ACS Patients With Obstruction Of Phlegm And Stasis Syndrome

ObjectiveThe paper aims to comprehensively explore the clinical application value of intestinal metabolite in cute coronary syndrome(ACS)of "obstruction of phlegm and stasis "syndrome.The correlation between trimethylamine-N-oxide(TMAO)and creatine kinase isoenzyme(CKMB)and the number of diseased vessels,as well as the predictive value of TMAO in adverse prognosis of ACS were analyzed.This article also observes the factors influencing the incidence of major cardiovascular adverse events(MACE)in patients with"obstruction of phlegm and stasis" syndrome,so as to provide theoretical basis of traditional Chinese and western medicine for prognosis assessment and secondary prevention.MethodsA total of 82 cases in Guangdong Provincial Hospital of Chinese Medicine from June 2017 to July 2018 who met the diagnostic criteria of ACS and Traditional Chinese Medicne(TCM)syndrome of mutual association of obstruction of phlegm and stasis were selected.20 cases in the negative control group who underwent coronary angiography during the same period and excluded coronary heart disease(CHD)were included for retrospective study.First,general laboratory tests,trimethylamine(TMA)and TMAO were compared between the two.groups.Secondly,the correlation between TMAO and clinical factors in patients with ACS was analyzed.Thirdly,taking MACE in 3 years after discharge as the outcome variable in ACS group,TMAO,creatine kinase(CK),white blood cell(WBC),neutrophilic granulocyte percentage(NEUT%)hypersensitive C-reactive protein(hs-CRP),systolic pressure(SBP),diastolic blood pressure(DBP)and body mass index(BMI)were used as explaining variables for Cox proportional risk regression.Resultsl.In the case control study,white blood cell(WBC),neutrophilic granulocyte percentage(NEUT%),aspartate aminotransferase(AST),creatinine(Cr),high density lipoprotein cholesterol(HDL-C),cardiac troponin T(cTnT),creatine kinase(CK),creatine kinase isoenzyme(CKMB),and "obstruction of phlegm and stasis" syndrome scores in ACS group were higher than those in control group.The difference between the two groups was statistically significant(P<0.05).There was no significant difference in total cholesterol(TC)and triglyceride(TG)levels between the two groups(P>0.05).2.In the case control study,the serum TMA level of ACS group was lower than that of control group,and the difference between the two groups was not statistically significant(P≥ 0.05).the TMAO level of ACS group was higher than that of control group,and the difference between the two groups was statistically significant(P<0.05).3.In the ACS group,the level of TMAO was positively correlated with the number of diseased vessels(r=0.253,P=0.022).Not related to creatine kinase isoenzyme(CKMB)(r=-0.134,P=0.229).4.In the ACS group,TMAO(HR=1.195,P=0.000),creatine kinase(CK)(HR=1.001,P=0.000),hypersensitive C-reactive protein(hs-CRP)(HR=1.024,P=0.000),systolic pressure(SBP)(HR=1.039,P=0.016),and body mass index(BMI)(HR=1.159,P=0.036)were independent predictors of MACE in 3 years(P<0.05).5.There are 19 MACE occurred in the ACS group.The 3-year non-incidence of MACE in 82 patients was 76.8%(95%CI:27.53-32.56).While the TMAO concentration was≤0.75μ mol/L,the 3-year non-incidence of MACE in the ACS group was 85.2%(95%CI:28.57-35.72).While the TMAO concentration was 0.76-1.99 μ mol/L,the 3-year non-incidence of MACE in the ACS group was 74.1%(95%CI:23.93-33.70).While the TMAO concentration was≧2.0 μ mol/L,the 3-year non-incidence of MACE in the ACS group was 71.4%(95%CI:24.83-33.59).ConclusionThe increase of WBC,NEUT%,AST,Cr,HDL-C,hs-CRP,CTnT,CK,CKMB、TMAO level and the"obstruction of phlegm and stasis" syndrome scores were correlated with the ACS.The level of TMAO was positively correlated with the number of diseased vessels,but not with the size of myocardial infarction.The concentration of TMAO was correlated with the incidence of 3-year MACE,and the higher the concentration of TMAO was,the higher the incidence of 3-year MACE was.During ACS patients,TMAO,CK,hs-CRP,SBP and BMI were independent predictors of the occurrence of MACE in 3 years.