尿酸与心力衰竭预后的Meta分析

Prognostic value of uric acid in heart failure: a meta-analysis

目的通过Meta分析方法,综合当前最新研究结果,系统评价尿酸与心衰患者预后的关系。方法计算机检索PubMed、EMBASE、The Cochrane Library数据库公开发表的文献,检索日期截止于2018年4月,同时手工检索纳入研究的参考文献。由2名评价员按照纳入和排除标准独立筛选文献、提取相关资料及文献质量评价,采用Revman 5.2软件进行Meta分析。结果高尿酸血症与心衰患者不良预后有关。尿酸升高的心衰患者其复合终点事件(HR=1.19,95%CI:1.14～1.25)、全因死亡(HR=1.3,95%CI:1.21～1.40)、心血管死亡(HR=1.43,95%CI:1.05～1.93)、再住院发生(HR=1.16,95%CI:1.07～1.26)的风险均高于尿酸正常的人群。亚组分析显示,尿酸与心衰患者预后的相关性和心衰类型、地区、心衰分级、随访时间、射血分数无关,然而,在利尿剂使用比例小于80%的人群中,尿酸的升高与心衰患者的预后无相关性(HR=1.40,95%CI:0.96～2.03)。结论尿酸升高的心衰患者不良事件发生风险显著升高,其预后价值不受心衰类型、地区、心衰分级、随访时间、射血分数的影响,利尿剂的使用情况可能影响尿酸对心衰预后的预测价值。

Objectives We performed a Meta-analysis for published literatures to assess the value of uric acid in heart failure.Methods We searched literatures of PubMed,EMBASE,and The Cochrane Library and reference lists of relevant articles from inception to April 2018.Two investigators screened out the literature independently according to the inclusion and exclusion criteria,and then extracted relevant information and evaluated literature quality.Revman 5.2 software was used for conducting a Meta-analysis.Results Hyperuricemia is associated with poor prognosis in patients with HF.Elevated uric acid in patients with HF has a higher risk of composite ending events(HR=1.19,95% CI:1.14~1.25),all-cause mortality(HR=1.3,95% CI:1.21~1.40),cardiovascular mortality(HR=1.43,95% CI:1.05~1.93),and rehospitalization(HR=1.16,95% CI:1.07~1.26).Subgroup analysis shows that the effect of elevated serum uric acid on HF prognosis is significant irrespective of HF type,area,NYHA class,duration of follow-up and ejection fraction.While in the group which the percentage of the patients who used diuretic is less than 80%,there is no significant association between elevated uric acid and poor prognosis in HF patients(HR=1.40,95% CI:0.96~2.03).Conclusion Elevated uric acid is associated with poor prognosis in HF patients.The effect of prognosis is significant irrespective of HF type,area,NYHA class,duration of follow-up and ejection fraction.The use of diuretic may impact the prognostic value for uric acid in HF.