血清尿酸对急性心力衰竭患者预后的预测价值

Value of uric acid in predicting prognosis of patients with acute heart failure

目的:研究血清尿酸水平对急性心力衰竭患者预后的预测价值。方法:选取我院急性心力衰竭或慢性心力衰竭急性发作的患者194例,随访1年,终点事件为出院后1年内出现心力衰竭再次发作、心绞痛、心肌梗死和心源性死亡。根据是否发生终点事件分为两组,比较两组各项检查指标。根据性别不同分层研究,绘制ROC曲线并进行生存分析来评价血清尿酸水平对急性心力衰竭患者预后的预测价值。结果:发生终点事件组左室射血分数、血钾、血尿酸、ALT、NT-proBNP与未发生终点事件组比较,差异具有统计学意义(P<0.05或P<0.01)。男性患者UA的最佳预测值为464μmol/L,灵敏度为71.9%,特异性为60.4%;女性患者UA的最佳预测值为384μmol/L,灵敏度为74.5%,特异性为61.7%;不同性别患者生存分析均显示高尿酸组终点事件发生率显著高于低尿酸组(P<0.05)。结论:血清尿酸能有效预测急性心力衰竭患者的预后,高尿酸者(男性UA>464μmol/L,女性UA>384μmol/L)预后差。

Objective:To study the value of uric acid(UA)in predicting the prognosis of patients with acute heart failure.Methods:194 patients with acute heart failure or acute exacerbation of chronic heart failure in our hospital were selected and followed up for 1 year;the end event was defined as recurrent heart failure,angina,myocardial infarction,and cardiac death.According to whether the end events happened,the patients were divided into end event group and non-end event group;the examination results were compared between the two groups.According to the sex,the ROC curve was drew and the Kaplan-Meier survival analysis was made to evaluate the value of UA in predicting the prognosis of patients with acute heart failure.Results:The difference of left ventricular ejection fraction,serum potassium,serum UA,ALT,NT-proBNP were statistically significant(P<0.05)between the end event group and the non-end event group.Among male patients,the best cutoff value of UA was 464|jLmol/L,the sensitivity was 71.9%,and the specificity was 60.4%.Among female patients,the best cutoff value of UA was 384 jjimol/L,the sensitivity was 74.5%,and the specificity was 61.7%.The Kaplan-Meire survival analysis showed that the end events happened more in hyper-UA group than those in hypo-UA group(P<0.05).Conclusion:The UA can predict the prognosis of patients with acute heart failure effectively,and those with hyper-UA(male:UA>464 jjimol/L;female:UA>384 jjimol/L)have poor prognosis.