尿酸与缺血性脑卒中rt-PA静脉溶栓预后:前瞻性研究

Association between serum uric acid levels and outcome in stroke patients with rt-PA intravenous thrombolysis: a prospectively study

目的探讨血清尿酸水平与rt-PA静脉溶栓急性缺血脑卒中临床预后的相关性。方法对108例急性缺血性脑卒中rt-PA静脉溶栓患者为研究对象,收集一般基线资料,并进行为期6 m的随访,评估神经功能恢复情况。结果 rt-PA溶栓前正常尿酸组平均尿酸为(285.5±49.6)μmol/L,高尿酸组为(460.3±58.5)μmol/L;溶栓前NIHSS评分正常尿酸组为(12±6),高尿酸组为(11±5.25)(P=0.41),无明显统计学意义。病程2 w时正常尿酸组评分为(9±4),高尿酸组为(7±4.25)(P=0.022)、高尿酸组中早期神经功能好转人数比例(24例,75.0%)明显高于正常尿酸组(40例,52.6%)(P=0.034);病程6 m时,高尿酸组神经功能预后不良(mRS 3~6)人数比例低于正常尿酸组(P=0.035)。多因素Logistic回归分析提示高尿酸水平(P=0.037,OR=0.467,95.0%CI:0.250~0.873)是rt-PA溶栓后远期预后的保护因素。结论高尿酸水平有助于rt-PA静脉溶栓治疗缺血性脑卒中早期及远期神经功能恢复,提示高尿酸水平是其近期及远期预后的保护性因素。

Objective To investigate the association between serum uric acid levels and outcome in stroke patients with rt-PA intravenous thrombolysis. Methods A total of 108 patients were included in the prospectively case study. Data on demographic characteristics,history of disease,admission UA and outcome at discharge were collected. Results Mean serum uric acid levels were（ 285. 5 ± 49. 6） μmol/L in the normal uric acid group,and（ 460. 3 ± 58. 5） μmol/L in the high uric acid group; High serum UA level was significantly associated with early neurological improvement（ P = 0. 034）,and also in NIHSS score（ P = 0. 022）. A significant difference was found in serum uric acid level between patients with good and patients with poor functional outcome（ P = 0. 035）. Multivariate Logistic regression analysis results showed that uric acid（ P = 0. 037,OR = 0. 467,95. 0% CI： 0. 250 - 0. 873） was the protective factor. Conclusion We found that increased serum uric acid levels are associated with better prognosis in patients with stroke treated with rt-PA intravenous thrombolytic therapy.