尿酸的院内变化值与急性心肌梗死患者死亡率的相关性

Correlation of Uric Acid in-hospital Changes with Mortality in Patients with Acute Myocardial Infarction

目的探讨院内血清尿酸（UA）水平的变化与急性心肌梗死（AMI）患者死亡率的相关性。方法连续收集2009-10～2013-06间于我院住院诊断为AMI的患者。整个住院期间,每日测量血UA水平,并对他们的入院UA值及UA峰值进行记录。研究主要终点为30 d和1年死亡率。结果研究共入选375例患者,平均年龄62.6岁,男性320例。30 d死亡率为7.2%,1年死亡率为10.9%。30 d内死亡患者的UA峰值比未死亡患者高（10.24 mg/d L比7.06 mg/d L,P〈0.001）,UA升高绝对值更大（1.7 mg/d L比0.7 mg/d L,P〈0.001）。UA峰值以及UA升高绝对值在预测30 d死亡率的最优值分别为9.65 mg/d L和2.35 mg/d L。同样,对于1年死亡患者,其UA峰值较未死亡者高（9.71 mg/d L比7 mg/d L,P〈0.001）,UA升高绝对值更高（1.5 mg/d L比0.6 mg/d L,P〈0.001）。UA峰值以及UA升高值在预测1年死亡率中的最优值分别为9.55 mg/d L和1.1 mg/d L。通过Cox回归分析,UA峰值及院内UA升高绝对值可预测30 d及1年死亡率的独立预测因素。结论 AMI患者的UA峰值以及院内UA升高绝对值,可以有效预测30 d和1年死亡率。连续的院内UA测量有助于AMI患者的预后评估。

Objective To explore the correlation of the changes of admission uric acid（ UA） levels in patients with acute myocardial infarction（ AMI）. Methods Studying patients with AMI from Oct,2009 to Jun,2013. UA levels were daily measured throughout hospitalization and their admission and peak values were recorded. End- points were 30- day and 1- year mortality. Results 375 patients were researched. The average age was 62. 6,and the male number was 320. Mortality rate at 30 days was 7. 2% and at 1 year was 10. 9%. Patients who died within 30 days exhibited higher peak UA（ 10. 24 mg / dl vs. 7. 06 mg / dl,P 0. 001） and absolute UA elevation（ 1. 7 mg /dl vs. 0. 7 mg / dl,P 0. 001）. Optimal values for predicting 30- day mortality were 9. 65 mg / dl for peak UA and 2. 35 mg / dl for UA elevation. Concerning 1- year mortality,deceased patients had higher peak UA levels（ 9. 71 mg / dl vs. 7 mg / dl,P 0. 001） and absolute UA elevation（ 1. 5 mg / dl vs. 0. 6 mg / dl,P 0. 001）. Optimal values for predicting 1- year mortality were 9. 55 mg / dl for peak UA and1. 1 mg / dl for UA elevation. With Cox regression analysis,peak UA and UA elevation were independent predictors of 30- day mortality.Conclusion Inpatients with AMI peak rather than admission UA levels,and absolute in- hospital UA elevation predict both 30- day and1- year mortality. Serial in- hospital UA measurements help prognostic information evaluation in AMI patients.