| Objectives:To observe the plasma trimethylamine N-oxide(TMAO)level of patients with coronary heart disease(CHD)with phlegm-dampness constitution,and to preliminary explore the clinical significance of the detection of trimethylamine oxide in coronary heart disease patients with phlegm-dampness constitutionMethods:1.According to the inclusion criteria,patients were admitted to the Department of cardiology disease of the Department of cardiology disease of Nanjing Chinese Medicine Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from April 2019 to December 2020 for chest pain.2.According to the standard of Constitution Identification of TCM(traditional Chinese medicine),patients was divided into two groups:phlegm-dampness constitution group and non-phlegm-dampness constitution group,with 95 cases in each group.Patients with coronary heart disease were diagnosed as the coronary heart disease group by coronary CTA or coronary angiography(CAG)in the two groups,and patients with coronary heart disease were excluded as the non coronary heart disease group.The patients with coronary heart disease were classified also according to the clinical classification criteria of coronary heart disease(chronic coronary syndrome,acute coronary syndrome),the results of coronary CTA and CAG(single coronary lesions,multiple coronary lesions),coronary lesions shown by coronary CTA or CAG(divided by Gensini score into mild coronary lesions and severe coronary lesions).And analysis of the collected data is conducted3.All subjects recorded in clinical data,including name,sex,age,height,weight and so on;personal history including smoking history,past medical history including type 2 diabetes,hypertension and family history of the same disease.The results of the tests were recorded in the case information collection form,including Trimetlylamine oxid(TMAO),Triglyceride(TG),Total Cholesterol(TC),Low Density Lipoprotein Cholesterol(LDL-C),High Density Lipoprotein Cholesterol(HDL-C),coronary CTA or CAG examination and so on.The identification of constitution was registered in the self-identification table of constitution of phlegm-dampness and the quantified integral table of phlegm-dampness constitution characteristics.All clinical data were analyzed by SPSS.The difference of TMAO and other indexs were compared between the case group and control group.These data were also compared among different clinical clasification of CHD,the number of coronary lesions and the degree of the lesions in the coronary heart disease group.Logistic regression analysis was used to explore whether plasma TMAO levels are risk factors for coronary heart disease and phlegm-dampness constitution.Results:1.Comparing the clinical data of 66 cases of phlegm-dampness constitution coronary heart disease group and 29 cases of phlegm-dampness constitution non coronary heart disease group,the levels of TMAO in plasma,LDL-C in blood,as well as the percentage of hypertension,smoking history,family history in coronary heart disease patients with phlegm-dampness constitution group were all higher than those of control group with phlegm dampness constitution.The differences were statistically significant(P<0.05).Among them,the level of TMAO in plasma and the percentage of hypertension and family history in patients with phlegm-dampness constitution coronary heart disease were significantly higher than those of the latter group(P<0.01)2.Logistic Regression analysis was used to analyze the difference between 66 cases of phlegm-dampness constitution coronary heart disease group and 29 cases of phlegm-dampness constitution control group.The result shows that higher level of TMAO in plasma is a risk factor for coronary heart disease in people with phlegm-dampness constitution(P<0.05).3.Comparing the clinical data of 41 patients with acute coronary syndrome and 25 patients with chronic coronary syndrome among phlegm-dampness constitution coronary heart disease group,the level of TMAO in plasma,as well as the percentage of hypertension and type 2 diabetes in patients with acute coronary syndrome were higher than those in patients with Chronic coronary syndrome.The differences were statistically significant(P<0.05).Among them,the percentage of hypertension cases in patients with acute coronary syndrome were significantly higher than those in the latter(P<0.01).The level of HDL-C in blood in patients with acute coronary syndrome were lower than those in patients with Chronic coronary syndrome.The differences were statistically significant(P<0.05).4.Comparing the clinical data of 42 patients with Single coronary lesions and 24 patients with multiple coronary lesions among phlegm-dampness constitution coronary heart disease group,the levels of TMAO in plasma,TC in blood,TG in blood,LDL-C in blood,BMI as well as the percentage of hypertension,history of smoking,type 2 diabetes in patients with multiple coronary lesions were higher than those in patients with single coronary lesions.The differences were statistically significant(P<0.05).Among them,the levels of TC in blood,TG in blood and the percentage of type 2 diabetes in patients with multiple coronary lesions were significantly higher than those in the latter(P<0.01).The level of HDL-C in blood in patients with multiple coronary lesions were significantly lower than those in patients with single coronary lesions.The differences were statistically significant(P<0.01).5.Comparing the clinical data of 30 patients with mild coronary lesions and 36 patients with severe coronary lesions among phlegm-dampness constitution coronary heart disease group,the levels of TMAO in plasma,TG in blood as well as the percentage of smoking history,type 2 diabetes in patients with severe coronary lesions were higher than those in patients with mild coronary lesions.The differences were statistically significant(P<0.05).Among them,level of TMAO in plasma and the percentage of type 2 diabetes in patients with severe coronary lesions were significantly higher than those in the latter(P<0.01).The level of HDL-C in blood in patients with severe coronary lesions were significantly lower than those in patients with mild coronary lesions.The differences were statistically significant(P<0.01).6.Comparing the clinical data of 57 cases of non-phlegm-dampness constitution coronary heart disease group and 38 cases of non-phlegm-dampness constitution non coronary heart disease group,the levels of TMAO in plasma,TC in blood,LDL-C in blood as well as the percentage of family history in coronary heart disease patients with non-phlegm-dampness constitution group were all higher than those of control group with non-phlegm-dampness constitution.The differences were statistically significant(P<0.05).Among them,the levels of TMAO in plasma and the percentage of family history in patients with non-phlegm-dampness constitution coronary heart disease group were significantly higher than those of the latter group(P<0.01).The level of HDL-C in blood in coronary heart disease patients with non-phlegm-dampness constitution group were lower than those in patients with non-phlegm-dampness constitution control group.The differences were statistically significant(P<0.05).7.Logistic Regression analysis was used to analyze the difference between 57 cases of non-phlegm-dampness constitution coronary heart disease group and 38 cases of non-phlegm-dampness constitution control group.The result shows that higher level of TMAO in plasma,family history and lower level of HDL-C in blood were risk factors for coronary heart disease in people with non-phlegm-dampness constitution(P<0.05).8.Comparing the clinical data of 26 patients with acute coronary syndrome and 31 patients with chronic coronary syndrome among non-phlegm-dampness constitution coronary heart disease group,the levels of TMAO in plasma,BMI as well as the percentage of hypertension and type 2 diabetes in patients with acute coronary syndrome were all higher than those in patients with chronic coronary artery disease.The differences were statistically significant(P<0.05).9.Comparing the clinical data of 40 patients with single coronary lesions and 17 patients with multiple coronary lesions among non-phlegm-dampness constitution coronary heart disease group,the levels of TMAO in plasma,TC in blood,TG in blood,LDL-C in blood,as well as the percentage of hypertension,type 2 diabetes in patients with multiple coronary lesions were all significantly higher than those in patients with single coronary lesion.The differences were statistically significant(P<0.05).Among them,the levels of TC in blood,TG in blood and the percentage of hypertension,type 2 diabetes in patients with multiple coronary lesions were significantly higher than those in the latter(P<0.01).10.Comparing the clinical data of 36 patients with mild coronary lesions and 21 patients with severe coronary lesions among non-phlegm-dampness constitution coronary heart disease group,the levels of TMAO in plasma,TC in blood as well as the percentage of hypertension,type 2 diabetes in patients with severe coronary lesions were all higher than those in patients with mild coronary lesions.The differences were statistically significant(P<0.05).Among them,levels of TMAO in plasma and the percentage of hypertension,type 2 diabetes in patients with severe coronary lesions were significantly higher than those in the latter(P<0.01)11.Comparing the clinical data of 66 cases of phlegm-dampness constitution coronary heart disease group and 57 cases of non-phlegm-dampness constitution coronary heart disease group,the levels of TMAO in plasma,TC in blood,TG in blood,BMI as well as the percentage of type 2 diabetes,smoking history in patients with phlegm-dampness constitution coronary heart disease group were all higher than non-phlegm-dampness constitution coronary heart disease group,the differences were statistically significant(P<0.05).Among them the level of TMAO in plasma and the percentage of type 2 diabetes in patients with phlegm-dampness constitution coronary heart disease were significantly higher than those of the latter(P<0.01).12.Logistic Regression analysis was used to analyze the difference between 66 cases of phlegm-dampness constitution coronary heart disease group and 57 cases of non-phlegm-dampness constitution coronary heart disease group.The result shows that higher level of TMAO in plasma were a risk factor for phlegm-dampness constitution in coronary heart disease patients(P<0.05)13.TMAO ROC curve analysis:the area under the curve of trimethylamine oxide on phlegm-dampness constitution is 0.711(95%CI:0.621?0.802,P<0.001),of which TMAO cutoff point is 6.71umol/L,sensitivity 0.712,sensitivity:0.614Conclusion:1.There is a correlation between TMAO levels in plasma and coronary heart disease in 123 patients with coronary heart disease observed2.There is a correlation between the level of TMAO in plasma and the phlegm-dampness constitution in 123 patients with coronary heart disease observed.3.Among the 123 patients with coronary heart disease observed,the level of TMAO is related to acute cardiovascular events,the number of coronary artery lesions and the degree of coronary artery disease.4.In patients with phlegm-dampness constitution coronary heart disease,the plasma TMAO level of the intestinal flora metabolites deserves attention,and its clinical significance looks forward to the development of large-scale,multi-center research in the future. |
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