血清尿酸与急性心肌梗死合并慢性肾功能不全患者预后的关系

Association between serum uric acid level and prognosis of patients with acute myocardial infarction andchronic renal dysfunction

目的探讨血清尿酸水平对合并有慢性肾功能不全的急性心肌梗死患者远期预后的影响。方法选取512例合并有慢性肾功能不全的急性心肌梗死患者,按血清尿酸水平分为低尿酸组（n=200）和高尿酸组（n=312）,分析各组病变血管、临床生化指标、合并症以及治疗情况,并对所有患者进行48个月随访,观察各组远期严重心血管不良事件。结果低尿酸组中共有2例患者死亡,高尿酸组中17例患者死亡（风险比：5.379;95%置信区间,1.204-24.035;P=0.028）。高尿酸组卒中、心衰和血运重建发生率均高于低尿酸组,且差异有统计学意义。结论合并有慢性肾功能不全的急性心肌梗死患者血清尿酸水平升高会导致患者远期死亡率、卒中发生率、心衰发生率和血运重建发生率增加。

Objective To determine the association between serum uric acid level and prognosis of patients withacute myocardial infarction and chronic renal dysfunction. Methods Totally 512 acute myocardial infarction patients with chronic renal dysfunction were enrolled in this study. These patients were assigned into two groups： high uric acid group（ n = 200） and low uric acid group（ n = 312）.Basic clinical characters were analyzed and major adverse cardiovascular events（ MACEs） were observed during 48-month follow-up.Results The results showed that during 48-month follow-up,death of any cause occurred in 1. 0% patients（ 2 of 200） in low uric acid group,as compared with 5. 3% in the high uric acid group（ 17 of 312）（ hazard ratio,5. 379; 95% confidence interval,1. 204 to24. 035; P = 0. 028）. The incidences of stroke,heart failure and revascularization weresignificantly higher in high uric acidgroup. Conclusions High serum uric acid level increases the incidences of death,revascularization,stroke and heart failure in acute myocardial infarction patients with chronic renal dysfunction.