无症状高尿酸血症对择期经皮冠状动脉介入治疗术后病死率的影响

Association of asymptomatic hyperuricemia with mortality in patients undergoing elective percutaneous coronary intervention

目的本研究旨在了解无症状高尿酸血症对择期经皮冠状动脉（冠脉）介入治疗（PCI）术后病死率的影响。方法入选2009年7月至2011年9月接受择期PCI治疗并且术前有尿酸记录的无痛风患者3 452例。高尿酸血症诊断标准定义为血尿酸水平男性〉420 μmol/L（7 mg/dl），女性〉357 μmol/L（6 mg/dl），将患者分为高尿酸组和正常尿酸组。经过平均1.5年的随访，比较两组患者术后病死率的差异。结果高尿酸组患者516例，正常尿酸组患者2 936例。高尿酸组患者年龄较大（P=0.003）；合并高血压（P〈0.001）、脑血管病（P=0.008）、陈旧性心肌梗死（P=0.024）、既往PCI病史比例较高（P=0.023）；白细胞（P〈0.001）、总胆固醇（P=0.029）、三酰甘油水平较高（P〈0.001）；糖尿病史比例（P=0.046）、左心室射血分数（P〈0.001）、肾小球滤过率（P〈0.001）、高密度脂蛋白胆固醇水平较低（P=0.001）。另外，高尿酸组患者住院期间应用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂（P=0.017）、利尿剂（P〈0.001）、冠状动脉多支血管病变比例（P=0.022）以及PCI处理病变数较高（P=0.014），而且完全血管重建率低（P=0.014）。高尿酸组患者术后病死率（4.1%比2.2%，P=0.011）明显高于正常尿酸组。多因素Cox回归分析显示，在校正了其他因素后，高尿酸是PCI术后病死率增加的独立危险因素（HR 3.252，95%CI 1.902-5.560，P〈0.001）。结论无症状高尿酸血症是接受择期PCI治疗的冠心病患者术后病死率增加的独立危险因素。

Objective This study investigated the influence of asymptomatic hyperuricemia on the prognosis of patients who had undergone elective percutaneous coronary intervention （ PCI）. Methods A total of 3 452 consecutive patients , who had preoperative serum uric acid level record and were without gout, underwent elective PCIs between July 2009 and September 2011 were included in this study. Patients were divided into two groups based on their preoperative serum uric acid levels. The association between baseline serum uric acid levels and postoperative mortality was investigated through 1.5 years of follow up. Results Of the 3 452 patients in the study population, 516 had elevated uric acid and 2 936 had normal uric acid. Patients in the elevated uric acid group were older, more frequently had prior history of hypertension, stroke, myocardial infarction and interventional procedure, less likely to have prior history of diabetes mellitus. Other significant differences included higher white blood cell, total cholesterol and triglyceride levels ; lower left ventricular ejection fraction, estimated glomerular filtration rate and high density lipoprotein （HDL） levels, more companied by muhivessel disease, more PCI lesions, lower complete revascularization rate. More patients with elevated uric acid level were treated with ACEI/ARB and diuretics at the time of hospital discharge. The results of a muitivariate Cox regression analysis revealed that preoperative elevated uric acid was an independent predictive factor for mortality after adjustment for other factors （hazard ratio 3. 252, 95 % confidence interval 1. 902 -5. 560, P 〈 0. 001 ）. Conclusion Asymptomatic hyperuricemia is an independent predictive factor of mortality in patients undergoing elective PCI.