摘要
Abstract
Objective To investigate the association between trimethylamine N-oxide(TMAO)and frailty,as well as long-term all-cause mortality risk,in elderly patients with cardiovascular diseases(CVD).Methods This prospective cohort study enrolled 437 elderly CVD patients[aged ≥65 years,mean age(75.17±6.66)years;53.1％male]hospitalized in the cardiology depart-ment of Beijing Hospital from September 2018 to April 2019.Frailty was assessed using three tools:a comprehensive geriatric assess-ment-based frailty index,the FRAIL scale,and the Clinical Frailty Scale(CFS).Baseline clinical data were collected,and fasting ve-nous blood samples were analyzed to measure TMAO levels.Patients were followed up for 2 years,with all-cause mortality as the pri-mary endpoint.Participants were stratified into quartiles according to TMAO levels.Group differences in frailty distribution were ana-lyzed using chi-square tests,and logistic regression was performed to evaluate the association between TMAO and frailty.Kaplan-Meier survival curves and log-rank tests were used to compare mortality rates between the low-TMAO and high-TMAO groups.Cox proportional hazards regression models were applied to assess the prognostic impact of TMAO and test its interaction effects with frail-ty.Results Across all three frailty assessment tools,the highest TMAO quartile showed a significantly higher prevalence of frailty compared with the lowest quartile(x2=13.92,13.41,17.26,respectively;all P＜0.05).Multivariate logistic regression revealed that the highest TMAO quartile was independently associated with frailty(OR=2.48,95％CI 1.33～4.65,P=0.005).Kaplan-Meier analysis showed that the high-TM AO/frail group had a significantly higher 2-year all-cause mortality rate(log-rank P＜0.0001).Multivariate Cox regression analysis indicated that high-TMAO patients had a 3.95-fold increased mortality risk(HR=3.95,95％CI 1.72～9.09,P=0.001),with significant interaction effects between TMAO and frailty across all assessment methods(all interaction P＜0.05).Conclusion Elevated TMAO levels are associated with frailty and independently predict 2-year all-cause mortality in elderly CVD patients.Frailty modifies the relationship between TMAO and adverse outcomes,highlighting their synergistic clinical implications.关键词
肠道菌群代谢物/氧化三甲胺/老年人/心血管疾病/衰弱/预后Key words
gut microbiota metabolites/trimethylamine N-oxide(TMAO)/the aged/cardiovascular diseases/frailty/prognosis
