尿酸与急性ST段抬高型心肌梗死患者PCI后冠状动脉血流相关性的研究

Correlation of serum uric acid levels with coronary flow in patients with ST-segment elevation myocardial infarction undergoing primary coronary intervention

目的评价急性ST段抬高型心肌梗死（STEMI）患者人院时血尿酸水平与经皮冠状动脉介入治疗（PCI）后冠状动脉血流的相关性。方法入选在发病后12h内行PCI治疗的276例STEMI患者进行前瞻．陛分析。将患者分为无复流组（TIMI血流0—2级）和复流正常组。采用多元Logistic回归分析评价血尿酸水平与急诊PCI后冠状动脉血流的相关性。结果无复流组的尿酸水平显著高于冠状动脉血流正常组。无复流组主要心血管事件（MACE）发生率高于血流正常组。受试者工作特征（ROC）曲线分析显示尿酸水平预测无复流的最佳切点值为345mmol／L，其预测无复流的敏感度和特异度分别为61．2％和77．5％。多元Logistic回归分析显示，入院时血尿酸（OR1．01，95％CI1．01—1．01，P〈0．01）、中性粒细胞计数（OR1．02，95％CI 1．00—1．06，P〈0．01）、入院时血糖水平（OR1．14，95％CI1．08—1．21，P〈0．01）、术前Killip分级≥4级（OR2．01，95％CI1．01-3．94，P=0．042）、再灌注时间（OR1．67，95％CI0．46—5．97，P=0．012）、PCI前血栓评分≥4级（OR2．67，95％CI1．29～5．13，P=0．008）、侧支循环分级≤1级（OR1．86，95％CI1．27—2．73，P=0．008）是直接PCI术无复流现象的独立危险因素。结论血尿酸水平是STEMI患者急诊PCI后无复流现象的独立危险因素，对于预测STEMI患者PCI后无复流并进行危险分层具有一定参考价值。

Objective To explore the association of the uric acid levels and coronary blood flow in patients with ST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods A total of 276 STEMI patients undergoing primary PCI were enrolled and divided into 2 groups based upon the Thrombolysis in Myocardial Infarction （TIMI）flow grade. No-reflow was defined as TIMI Grade 0, 1 and 2 flows. The association of uric acid levels on admission with TIMI flow grade after PCI was assessed by multivariate Logistic regression. Major adverse cardiac events （MACE） were defined as death, non-fatal myocardial infarction and need for repeat percutaneous revascularization or coronary artery bypass grafting. Results The uric acid level was significantly higher in the no-reflow group （n= 57） than that of the normal-flow group （n = 219, 372 ± 111 vs 303 ±102, P 〈 0.01）. In-hospital MACEs were significantly higher in the patients with no reflow （8.8% vs 1.8%, P =0. 016）. A uric acid level ≥345 mmol/L measured on admission had a 61.2% sensitivity and 77.5% specificity in predicting no-reflow at ROC curve analysis. At multivariate analyses, high plasma uric acid （ OR 1.01, 95% CI 1.01 - l. 01, P 〈0. 01 ）, neutrophil count （ OR 1.02, 95% CI 1.00 - 1.06, P 〈0. 01 ）, admission plasma glucose （OR 1.14, 95% CI 1.08 - 1.21, P 〈 0.01 ）, time from pain to PCI （ OR 1.67,95% CI 0.46 - 5.97, P = 0. 012 ） , pre PCI thrombus score ≥ 4 （ OR 2. 67,95% CI 1.29 - 5.13, P = 0. 008 ）, collateral circulation grade ≤1 （ OR 1.86,95% CI 1.27 - 2.73, P = 0. 008 ）, and Killip classes （ OR 2. 01, 95% CI 1.01 -3.94, P = 0. 042） were independent predictors of no-reflow post primary PC I. Conclusions The plasma level of uric acid on admission is a strong and independent predictor of poor coronary blood flow following at post-primary PCI among STEMI patients. Uric acid levels may be a useful biomarker of risk stratification.