血尿酸水平与高原中青年急性ST段抬高型心肌梗死患者冠状动脉病变程度及近期预后的关系研究

Relationship between Blood Uric Acid and Severity of Coronary Artery Lesions and Short-term Prognosis in Young and Middle-aged Patients with Acute ST-segment Elevation Myocardial Infarction in Plateau Section

目的分析血尿酸水平与高原中青年急性ST段抬高型心肌梗死(ASTEMI)患者冠状动脉病变程度及近期预后的关系。方法选取2010年1月—2016年6月在雅安市人民医院行经皮冠状动脉介入治疗(PCI)的中青年ASTEMI患者99例,根据血尿酸水平分为正常组(n=38)和高尿酸血症组(n=61)。比较两组患者基线资料、治疗情况;随访90 d,比较两组患者随访期间心源性死亡、心肌梗死再发及心力衰竭情况。结果两组患者年龄、性别、吸烟史、高血压发生率、血糖异常发生率、血脂异常发生率、肥胖者所占比例及冠心病家族史比较,差异无统计学意义(P>0.05);高尿酸血症组患者超敏心肌肌钙蛋白T(hs-c Tn T)水平高于正常组(P<0.05)。两组患者症状-入门时间、入门-球囊扩张时间、血栓抽吸者所占比例及罪犯血管为前降支者所占比例比较,差异无统计学意义(P>0.05);高尿酸血症组患者多支病变者所占比例高于正常组,住院时间长于正常组(P<0.05)。两组患者随访期间心源性死亡率、心肌梗死再发率比较,差异无统计学意义(P>0.05);高尿酸血症组患者心力衰竭发生率高于正常组(P<0.05)。相关性分析结果显示,血尿酸水平与高原中青年ASTEMI患者hs-c Tn T水平(r=0.267)、冠状动脉病变支数(rs=0.219)呈正相关(P<0.05)。结论血尿酸水平与高原中青年ASTEMI患者冠状动脉病变程度及病变支数有关,且合并高尿酸血症的高原中青年ASTEMI患者近期心力衰竭发生风险较高。

Objective To analyze the relationship between blood uric acid and severity of coronary artery lesions and short-term prognosis in young and middle-aged patients with acute ST-segment elevation myocardial infarction（ ASTEMI） in plateau section. Methods A total of 99 young and middle-aged patients with ASTEMI were selected in the People＇s Hospital of Yaan from January 2010 to June 2016,all of them received PCI,and they were divided into A group（ with normal blood uric acid,n = 38） and B group（ with hyperuricemia, n = 61） according to the blood uric acid. Baseline data, therapeutic condition,cardiogenic mortality,recurrence of myocardial infarction and incidence of heart failure during the 90-day follow-up were compared between the two groups. Results No statistically significant differences of age,gender,smoking history,incidence of hypertension, pathoglycemia or dyslipidemia, proportion of obesity patients, or family history of coronary heart disease was found between the two groups（ P〈0. 05）; hs-c Tn T of B group was statistically significantly higher than that of A group（ P〈0. 05）. No statistically significant differences of attack-door time,door-balloon time,proportion of patients undergoing thrombus aspiration or patients with anterior descending branch as culprit vessel was found between the two groups（ P〈0. 05）; proportion of patients with multi-vessel lesions of B group was statistically significantly higher than that of A group,meanwhile hospital stays of B group was statistically significantly longer than that of A group（ P〈0. 05）. No statistically significant differences of cardiogenic mortality or recurrent rate of myocardial infarction was found between the two groups（ P〈0. 05）; incidence of heart failure of B group was statistically significantly higher than that of A group（ P〈0. 05）. Correlation analysis results showed that, blood uric acid was positively correlated with hs-c Tn T（ r = 0. 267） and number of stenosed coronary arteries（ rs= 0. 219） in young and middle-aged patients with ASTEMI in plateau section（ P〈0. 05）. Conclusion Blood uric acid is significantly correlated with severity of coronary artery lesions and number of stenosed coronary arteries in young and middle-aged patients with ASTEMI in plateau section,and hyperuricemia may increase the short-term risk of heart failure.