高尿酸血症对急性脑梗死患者病情及预后的影响

Influence of hyperuricemia on disease condition and prognosis in patients with acute cerebral infarction

目的观察高尿酸血症对急性脑梗死患者病情严重程度和预后的影响。方法连续入组发病3 d内的急性脑梗死患者共530例,记录临床危险因素、实验室检查指标,分析高尿酸血症与急性脑梗死患者入院时病情严重程度、住院14 d时病情变化和90 d预后的关系。结果高尿酸血症与急性脑梗死患者入院病情严重程度无关(P>0.05)。多因素Logistic回归分析显示,14 d时合并高尿酸血症患者预后较好(OR=0.73,95%CI:-0.84^-0.13),合并高胆固醇血症患者预后较差(OR=1.14,95%CI:0.67~1.85),脑梗死患者90 d时合并HUA(OR=1.03,95%CI:0.47~1.23)、吸烟(OR=1.27,95%CI:0.52~1.37)及入院时病情严重(OR=1.47,95%CI:0.82~1.59)预后均差。结论高尿酸血症对急性脑梗死患者不同时期的影响可能不同,在发病时及14 d内可能起保护作用,而对于90 d则有不利影响,二级预防仍要降低尿酸水平。

Objective To observe the influence of hyperuricemia on disease severity and prognosis in patients with a-cute cerebral infarction（ACI）. Methods Five hundred and thirty patients with ACI attacked within 3 days were selected. The clinical risk factors and laboratory examination indexes were recorded in order to analyze the relationship between hyperuricemia and severity of disease condition on admission,change of disease condition in 14-day after hospitaliza-tion and 90-day prognosis. Results There was no relationship between hyperuricemia and severity of disease condition on admission（P〉0.05）.Logistic regression analysis on multiple factors influencing prognosis indicated that prognosis was favorable when combining with hyperuricemia in 14-day （OR=0.73,95%CI：-0.84--0.13）,while poor prognosis occurred when combined with hypercholesteremia （OR=1.14,95%CI：0.67-1.85）.The prognosis were all poor when combined with hyperuricemia in patients with cerebral infarction（OR=1.03,95%CI：0.47-1.23）,smoking（OR=1.27,95%CI：0.52-1.37）,and patients with severe disease condition on admission（OR=1.47,95%CI：0.82-1.59）. Conclusion Hyperuricemia has differ-ent influences on ACI patients in different periods,which may play a protective role ranging from disease onset to 14-day.However,it is unfavorable for 90-day prognosis and secondary prevention still focuse on decreasing the level of uric acid.