血清尿酸水平对急性缺血性卒中患者静脉溶栓治疗后转归的影响

Effect of serum uric acid level on outcomes after intravenous thrombolysis in patients with acute ischemic stroke

目的 探讨血清尿酸水平对急性缺血性卒中患者静脉溶栓治疗后转归的影响.方法回顾性纳入2014年4月至2018年1月在深圳市第二人民医院卒中单元接受静脉溶栓的急性缺血性卒中患者.根据发病后3个月时改良Rankin量表评估临床转归,〉2分定义为转归不良.对转归良好组与转归不良组的人口统计学和临床资料进行比较.采用多变量logistic回归分析确定临床转归的独立影响因素.结果共纳入155例患者,转归良好组92例（59.4％）,转归不良组63例（40.6％）.转归良好组血清尿酸水平显著高于转归不良组[（365.465±100.055）μmol/L对（325.958±114.704）μmol/L;t=-2.227,P=0.027].多变量logistic回归分析显示,低血清尿酸水平与转归不良存在显著独立正相关联系[按四分位数分为4个水平,以 ≥416.01μmol/L为参照;350.11～416.00μmol/L：优势比（odds ratio,OR）1.414,95％ 可信区间（confidence interval,CI）0.375～5.339,P=0.609;278.61～350.10μmol/L：OR 3.020,95％CI 0.878～10.390,P=0.080;≤278.60μmol/L：OR 4.194,95％CI 1.194～14.726,P=0.025;趋势性检验P=0.013].结论血清尿酸水平较高与急性缺血性卒中患者静脉溶栓后转归良好独立相关.

Objective To investigate the effect of serum uric acid level on outcomes after intravenous thrombolysis in patients with acute ischemic stroke. Methods From April 2014 to January 2018I, patients with acute ischemic stroke received intravenous thrombolysis at the stroke unit of Shenzhen Second People＇s Hospital were enrolled retrospectively. The clinical outcomes were assessed according to the modified Rankin scale at 3 months after onset, 〉 2 were defined as poor outcome. The demographic and clinical data were compared between the good outcome group and the poor outcome group. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcomes. Results A total of 155 patients were enrolled, including 92 （59. 4％） in the good outcome group and 63 （40. 6％） in the poor outcome group. The serum uric acid level in the good outcome group was significantly higher than that in the poor outcome group （365. 465 ±100. 055 μmol/L vs. 325. 958 ±114. 704 μmol/L; t = -2. 227,P = 0. 027）. Multivariate logistic regression analysis showed that there was a significant positive correlation between low serum uric acid levels and poor outcomes （They were divided into 4 levels according to the quantiles. ≥416. 01 μmol/L as reference; 350. 11- 416. 00 μmol/L： odds ratio [ OR ] 1. 414, 95％ confidence interval [CI] 0. 375-5. 339, P = 0. 609; 278. 61-350. 10 μmol/L： OR 3. 020, 95％ CI 0. 878- 10. 390, P = 0. 080; ≤ 278. 60 μmol/L： OR 4. 194, 95％ CI 1. 194-14. 726, P = 0. 025; trend test P =0. 013]. Conclusion Higher serum uric acid level is independently associated with good outcomes after intravenous thrombolysis in patients with acute ischemic stroke.