冠心病患者尿酸与外周动脉阻塞性疾病的相关性研究

Study on the independent association of uric acid levels with peripheral arterial disease in Chinese patients with coronary heart disease

目的评价冠心病患者尿酸与外周动脉阻塞性疾病（PAD）的关系.方法连续入选上海第十人民医院等32家医院的冠心病住院患者（年龄≥50岁）3251例为研究对象;使用SPSS 11.5软件建立数据库并进行统计分析;测量踝臂指数（ABI）并检测尿酸水平;ABI〈0.9诊断为PAD;在多因素logistic分析中调整混杂变量（P〈0.10）;通过受试者工作特征曲线（ROC曲线）确定尿酸作为冠心病患者PAD诊断的参考指标的最佳界值.结果在单变量分析中,PAD组尿酸水平及高尿酸血症患病率明显高于非PAD组（P〈0.001）;把尿酸水平五等份后各等级的PAD患病率依次为23.2%、27.4%、36.1%、43.2%、72.7%（趋势x2检验,P〈0.05）;尿酸作为连续性变量在多因素logistic分析中OR值为1.002（95%CI：1.001～1.002）;通过ROC曲线得到尿酸作为冠心病患者PAD诊断的参考指标的最佳界值为227.2 μmol/L,灵敏度为0.846,特异度为0.203,曲线下面积为0.521（95%CI：0.504～0.547）;以此界值划分尿酸水平为二分类变量,在多因素logistic分析中OR值为1.292（95%CI：1.047～1.596）,剔除使用利尿剂的研究对象后得到类似的结果.结论冠心病患者（年龄≥50岁）的尿酸是PAD一个显著的、独立的危险因素.

Objective To evaluate the relationship between uric acid（UA） and peripheral arterial disease（PAD） in Chinese patients with coronary heart disease （CHD）. Methods UA levels and PAD were evaluated in 3251 Chinese hospitalized patients with CHD （age≥50 years）. PAD was diagnosed when the ankle-brachial index was 〈 0.9 but patients with an ankle-brachial index of 〉 1.4 were excluded because of false negative rate. Potential confounding variables with P〈 0.10 were adjusted for multivariate analysis. Results In univariate analysis, UA levels were higher in patients with PAD than in those without PAD （349.80 μmol/L± 128.45 μmol/L vs. 323.00 μmol/L± 110.72 μmol/L, P〈 0.001）. Rate of hyperuricemia in patients with PAD and without PAD were 31.62% and 22.48% （P〈 0.001 ） respectively. Prevalence rates of PAD for quintiles of UA level were 23.2 %, 27.4 % , 36.1%, 43.2 % and 72.7 % ,respectively （P-trend 〈 0.05）. With UA level as a continuous variable, the multivariate-adjusted odds ratio for PAD was 1. 002 （95 % confidence interval ： 1.001-1. 002） （ P 〈 0.001 ）. The optimal cut-off point for UA as determined by the receiver operating characteristic curve, was 227.2μmol/L. The sensitivity and specificity at this cut-off point were 84.6 % and 20.3 %, respectively. The area under curve was 0. 521（95 % condidence interval： 0. 504-0. 547） and the multivariate-adjusted odds ratio for PAD for UA above this level was 1. 292 （95 % confidence interval： 1. 047-1. 596） （ P 〈 0.01 ）. The results, however, after exclusion those cases who used diuretics, were similar. Conclusion Elevated uric acid level seemed a significant and independent risk factor for PAD in Chinese hospitalized patients with CHD（age≥50 years）.