血清尿酸浓度对急性缺血性卒中患者短期转归的影响：回顾性病例系列研究

Effect of serum uric acid concentration on short-term outcome in patients with acute ischemic stroke： a retrospective case series study

目的探讨血清尿酸浓度对急性缺血性卒中患者短期转归的影响。方法选取就诊的缺血性卒中患者，根据出院时改良Rankin量表（modified Rankin Scale，mRS）评分将患者分为转归良好组（mRS评分0～2分）和转归不良组（mRS评分3～6分），比较两组基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke ScAtle，NIHSS）评分、血清尿酸（serum uric acid，SUA）水平以及其他人口统计学和临床资料。结果共纳入311例急性缺血性卒中患者，转归良好组185例，转归不良组126例。转归不良组基线NIHSS评分（中位数，四分位间距）[7（4～11）分对3（2～4）分；Z=9．858，P=0．001]、既往2型糖尿病（29．4％对14．1％;Х62=10．877，P=0．001）和TIA史（27．8％对17．8％;Х^2=4．335，P=0．037）患者构成比显著性高于转归良好组，而SUA水平[（331．984±118．995）mmol／L对（363．276±100．743）mmol／L；t=2．497，P=0．013]和NIHSS评分〈9分的患者构成比（63．5％对96．8％;Х^2=59．562，P=0．000）显著性低于转归良好组。SUA较低四分位数组基线NIHSS评分和出院mRS评分更高（P均〈0．01）。多变量logistic回归分析显示，SUA增高为急性缺血性卒中患者短期转归的独立保护因素（优势比0．997，95％可信区间0．995～0．999；P=0．016）。结论SUA增高是急性缺血性卒中患者短期转归的独立保护因素。

Objective To investigate the impact of serum uric acid concentration on short-term outcome in patients with acute ischemic stroke. Methods The patients with acute ischemic stroke were collected. According to the modified Rankin scale （mRS） scores at discharge, the patients were divided into either a good outcome group （mRS score 0 to 2） or a poor outcome group （mRS score 3 to 6）. The baseline National Institutes of Health Stroke Scale （NIHSS） scores, serum uric acid （SUA） levels and other demographic and clinical data in both groups were compared. Results A total of 311 patients with acute ischemic stroke were enrolled in the study. There were 185 patients in the good outcome group and 126 in the poor outcome group. The patients＇ constituent ratios of the baseline NIHSS scores （median [ interquartile range ] ） （7 [ 4- 11 ] vs. 3[2 -4] ; Z = 9. 858, P = 0. 001）, previous type 2 diabetes meUitus （29.4% vs. 14. 1% ;Х^2 = 10. 877, P = 0. 001） and history of TIA （27. 8% vs. 17. 8% ;Х^2 =4. 335, P =0. 037） were siglificantly higher than those in the poor outcome group, while the patients＇ constituent ratio of the SUA levels （331.984±118. 995 mmol/L vs. 363. 276 ±100. 743 mmol/L; t =2. 497, P =0. 013） and the NIHSS score 〈9 （63.5% vs. 96. 8% ;Х^2 =59. 562, P = 0. 000） were significantly lower than those in the good outcome group. The baseline NIHSS and mRS scores at discharge were higher in the SUA lower quartile group （all P〈0. 01）. Multivariate logistic regression analysis showed that the increased SUA was an independent protective factor for short-term outcome in patients with acute ischemic stroke （odds ratio 0. 997, 95% confidence interval 0. 995 - 0. 999; P = 0. 016）. Conclmiom The increased SUA is an independent protective factor for short-term outcome in patients with acute ischemic stroke.