血清尿酸水平对无神经症状颈动脉粥样硬化患者长期预后的影响研究

Long-term Prognosis in Patients with Neurologically Asymptomatic Carotid Atherosclerosis Influenced by Serum Uric Acid Level

目的探讨血清尿酸水平预测无神经症状颈动脉粥样硬化患者长期预后的意义。方法收集2012年12月—2015年12月沧州市中心医院收治的656例无神经症状颈动脉粥样硬化患者的临床资料。依据患者血清尿酸水平四分位数间距将其分为>75%组(n=161)、51%~75%组(n=167)、25%~50%组(n=163)、<25%组(n=165)。回顾性分析患者的性别、年龄、体质指数(BMI)、合并症(高血压、糖尿病、高脂血症)、吸烟情况、生化指标[血清尿酸、同型半胱氨酸(Hcy)水平]、主要终点事件(全因死亡)、次要终点事件(心脑血管疾病致死),观察时间截至2015-12-31。结果 4组患者性别、高血压发生率、高脂血症发生率、吸烟率、血清尿酸水平、Hcy水平比较,差异有统计学意义(P<0.05)。4组患者全因死亡率、心脑血管疾病致死率比较,差异有统计学意义(P<0.05);Spearman秩相关分析结果显示,血清尿酸水平与无神经症状颈动脉粥样硬化患者全因死亡率、心脑血管疾病致死率呈正相关(rs值分别为0.183、0.099,P值分别为<0.001、0.002)。截至观察终点,共出现全因死亡患者170例,心脑血管疾病致死患者109例。4组患者全因死亡的生存曲线、心脑血管疾病致死的生存曲线比较,差异有统计学意义(χ~2值分别为36.100、16.898,P值分别为<0.001、0.001)。Cox比例风险回归模型分析结果显示,血清尿酸水平是无症状颈动脉粥样硬化患者全因死亡[RR=1.023,95%CI(1.018,1.028)]以及心脑血管疾病致死[RR=1.011,95%CI(1.008,1.014)]的独立影响因素(P<0.05)。结论血清尿酸水平与无神经症状颈动脉粥样硬化患者全因死亡率以及心脑血管疾病致死率密切相关,且高血清尿酸水平提示患者预后不良。

Objective To investigate the impact of serum uric acid （SUA） level on long -term prognosis in patients with neurologically asymptomatic carotid atherosclerosis （NACA） . Methods The clinical data of 656 patients with NACA who received inpatient treatment in Cangzhou Central Hospital from December 2012 to December 2015 were collected. They were divided into 4 groups based on the interquartile range of serum uric acid level, 〉 75% group （n = 161 ）, 51% - 75% group （n = 167）, 25% - 50% group （ n = 163 ）, 〈 25% group （ n = 165 ） . The baseline information of patients was retrospectively analyzed, including gender, age, BMI, complication （hypertension, diabetes, hyperlipemia ）, smoking, biochemical markers （level of SUA and Hcy）, primary endpoint event （ all - cause mortality）, ssecordary endpoint event （ cardiovascular and cerebrovascular morbidity） . The deadline was December 31st, 2015. Results Gender distribution, prevalence of hypertension, hyperlipemia and smoking, levels of SUA and Hcy differed significantly among the 4 groups （ P 〈 0. 05 ） . The all - cause mortality and cardiovascular and cerebrovascular mortality in the 4 groups varied obviously （ P 〈 0. 05 ） . Spearman rank correlation analysis indicated that there was a positive correlation between SUA level and all -cause mortality （rs =0. 183, P 〈 0. 001 ） ; SUA level presented a positive correlation with the cardiovascular and cerebrovascular mortality （ rs = 0. 099, P = 0. 002） . Up to end point, there were 170 deaths from all causes and 109 deaths due to cardiovascular and cerebrovascular diseases in total. The survival curves of deaths from all causes in the 4 groups were significantly different （ X2 = 36. 100, P 〈 0. 001 ） . The survival curve of deaths due to cardiovascular and cerebrovascular diseases varied substantially by group （ X2 = 16. 898, P = 0.001 ） . The analysis with Cox proportional hazard regression models manifested that SUA level was an independent associated factor for deaths from all causes [ RR = 1. 023, 95% CI （ 1. 018, 1. 028） ] and for deaths due to cardiovascular andr cerebrovascular diseases [ RR = 1.011, 95% CI （ 1. 008, 1. 014） ] in neurologically asymptomatic carotid atherosclerotic patients （P 〈 0. 05 ） . Conclusion SUA level is closely related to all - cause mortality and cardiovascular and cerebrovascular mortality in patients with neurologically asymptomatic carotid atherosclerosis. Increased SUA level indicates poor prognosis of the patients.