血浆尿酸水平对急性卒中后病人远期预后的影响

Effects of serum uric acid levels on long-term outcomes of patients with acute stroke

目的探讨急性卒中后血浆尿酸水平与病人死亡率、生存状态以及血管事件再发率的关系。方法选择2780例急性缺血性脑卒中和原发性颅内出血病人,分析血浆尿酸浓度与病人卒中后90d时生存状态,再发性心肌梗死、缺血性卒中或血管事件死亡率的关系。采用Logistic回归分析血浆尿酸水平与病人不良预后的相关性,并矫正卒中严重程度和已知的临床、生化、影像学方面等因素对卒中预后的影响;采用Cox回归评估尿酸水平与血管事件发生率的相关性。结果单纯血浆尿酸水平增高即可提示卒中后90 d时病人预后不良(尿酸每增加0.1 mmol/L,比数比为0.76,95%可信区间为0.68～0.95),血管事件发生率随尿酸水平增高而增加(尿酸每增加0.1 mmol/L,相对危险性为1.28,95%可信区间为1.19～1.46),高尿酸导致血管事件发生率在糖尿病病人中尤为突出(尿酸每增加0.1 mmol/L,相对危险度为1.23,95%可信区间为1.28～1.42)。结论不依赖于其他危险因素,高尿酸即可独立提示卒中病人预后不良(死亡或致残),并有较高的血管冉发事件。尽管尿酸在卒中的病理生理机制方面作用尚不清楚,但降低尿酸水平对病人预后是有益的。

Objective To explore the association of serum uric acid levels with mortality, living conditions and the recurrence rate of vascular events after acute stroke. Methods We analyzed the association of serum uric acid levels with 90-day living conditions and the subsequent occurrence of recurrent myocardial infarction, ischemic stroke or mortality of vascular events, in 2 780 patients with acute ischemic stroke or primary intracranial hemorrhage. The Logistic regression was used to analyze the correlation between serum uric acid levels and the poor prognosis of stroke, and rectify the severity of stroke and the known impact of clinical, biochemical and imaging factors on prognosis of stroke; Cox regression was applied to appraise the correlation between uric acid levels and vascular event incidence. Results Elevated serum uric acid levels predicted poor level of 90-day stroke prognosis （odds ratio, 0.76 per additional 0. l mmol/L uric acid; 95% CI, 0.68-0.95）. Vascular event incidence increased with the increasing of uric acid levels （relative hazard, 1.28 per additional 0.1 mmol/L uric acid; 95% CI, 1.19-1.46）. Vascular event incidence induced by high uric acid levels was particularly prominent in diabetic patients （relative risk, 1.23 per additional 0.1 mmol/L uric acid; 95% CI, 1.28-1.42）. Conclusion Independent of other risk factors, higher serum uric acid levels can predict poor outcomes （dead or in care） and comparatively high recurrence rate of vascular events in patients with stroke. The role of uric acid in pathophysiological mechanism of stroke remains uncertain, but the intervention of lowering the uric acid level may be worthwhile.