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Assessment of trimethylamine N-oxide (TMAO) as a potential biomarker of severe stress in patients vulnerable to posttraumatic stress disorder (PTSD) after acute myocardial infarction
European Journal of Psychotraumatology ( IF 5.783 ) Pub Date : 2021-05-31 , DOI: 10.1080/20008198.2021.1920201
Andreas Baranyi 1 , Dietmar Enko 2 , Dirk von Lewinski 3 , Hans-Bernd Rothenhäusler 1 , Omid Amouzadeh-Ghadikolai 4 , Hanns Harpf 5 , Leonhard Harpf 5 , Heimo Traninger 5 , Barbara Obermayer-Pietsch 6 , Melanie Schweinzer 1 , Celine K Braun 1 , Andreas Meinitzer 2
Affiliation  

ABSTRACT

Background: Posttraumatic stress disorder (PTSD) is a frequently observed stress-related disorder after acute myocardial infarction (AMI) and it is characterized by numerous symptoms, such as flashbacks, intrusions and anxiety, as well as uncontrollable thoughts and feelings related to the trauma. Biological correlates of severe stress might contribute to identifying PTSD-vulnerable patients at an early stage.

Objective: Aims of the study were (1) to determine whether blood levels of trimethylamine N-oxide (TMAO) vary immediately after AMI in patients with/without AMI-induced PTSD symptomatology, (2) to investigate whether TMAO is a potential biomarker that might be useful in the prediction of PTSD and the PTSD symptom subclusters re-experiencing, avoidance and hyperarousal, and (3) to investigate whether TMAO varies immediately after AMI in patients with/without depression 6 months after AMI.

Method: A total of 114 AMI patients were assessed with the Hamilton-Depression Scale after admission to the hospital and 6 months later. The Clinician Administered PTSD Scale for DSM-5 was used to explore PTSD-symptoms at the time of AMI and 6 months after AMI. To assess patients’ TMAO status, serum samples were collected at hospitalization and 6 months after AMI.

Results: Participants with PTSD-symptomatology had significantly higher TMAO levels immediately after AMI than patients without PTSD-symptoms (ANCOVA: TMAO(PTSD x time), F = 4.544, df = 1, p = 0.035). With the inclusion of additional clinical predictors in a hierarchical logistic regression model, TMAO became a significant predictor of PTSD-symptomatology. No significant differences in TMAO levels immediately after AMI were detected between individuals with/without depression 6 months after AMI.

Conclusions: An elevated TMAO level immediately after AMI might reflect severe stress in PTSD-vulnerable patients, which might also lead to a short-term increase in gut permeability to trimethylamine, the precursor of TMAO. Thus, an elevated TMAO level might be a biological correlate for severe stress that is associated with vulnerability to PTSD.



中文翻译:

评估三甲胺 N-氧化物 (TMAO) 作为急性心肌梗死后易患创伤后应激障碍 (PTSD) 患者严重应激的潜在生物标志物

摘要

背景: 创伤后应激障碍 (PTSD) 是急性心肌梗死 (AMI) 后常见的应激相关障碍,其特征是许多症状,例如闪回、闯入和焦虑,以及与创伤相关的无法控制的想法和感受. 严重压力的生物学相关性可能有助于在早期识别易患 PTSD 的患者。

目的: 本研究的目的是 (1) 确定有/无 AMI 诱发的 PTSD 症状的患者在 AMI 后的血液水平是否立即发生变化,(2) 调查 TMAO 是否是一种潜在的生物标志物可能有助于预测 PTSD 和 PTSD 症状亚群的再体验、回避和过度兴奋,以及 (3) 调查 AMI 后 6 个月有/无抑郁症的患者在 AMI 后 TMAO 是否立即发生变化。

方法:共有 114 名 AMI 患者在入院后和 6 个月后使用汉密尔顿抑郁量表进行评估。DSM-5 的临床医生管理的 PTSD 量表用于探索 AMI 时和 AMI 后 6 个月的 PTSD 症状。为了评估患者的 TMAO 状态,在住院时和 AMI 后 6 个月收集了血清样本。

结果:与没有 PTSD 症状的患者相比,AMI 后具有 PTSD 症状的参与者的 TMAO 水平显着更高(ANCOVA:TMAO(PTSD x 时间),F = 4.544,df = 1,p = 0.035 。随着在分层逻辑回归模型中包含额外的临床预测因子,TMAO 成为 PTSD 症状学的重要预测因子。在 AMI 后 6 个月,在有/没有抑郁症的个体之间检测到 AMI 后的 TMAO 水平没有显着差异。

结论:AMI 后立即升高的 TMAO 水平可能反映了 PTSD 易感患者的严重压力,这也可能导致肠道对三甲胺(TMAO 的前体)的通透性短期增加。因此,升高的 TMAO 水平可能是与易患 PTSD 的严重压力相关的生物学关联。

更新日期:2021-05-31
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