血尿酸在冠脉病变程度中的诊断价值

Diagnostic Value of Serum Uric Acid in the Degree of Coronary Artery Disease

目的分析冠状动脉粥样硬化性心脏病(CHD)患者血尿酸(SUA)的水平,探讨SUA在冠脉病变严重程度中的诊断价值。方法收集我院行冠脉造影(CAG)检查的200例可疑冠心病患者,根据造影结果,包括无冠脉病变者18例(对照组)和冠脉病变者182例(观察组)。观察组依据冠脉病变支数分为单支病变组(68例)、双支病变组(67例)和三支病变组(47例)3个亚组;依据冠脉狭窄程度是否超过75%(至少有一支病变血管符合条件),分为≥75%与<75%两亚组。比较两组及各亚组间SUA的差异,绘制SUA诊断冠脉病变支数的受试者工作特征(ROC)曲线。结果观察组SUA水平(388.89±103.45)明显高于对照组(313.53±53.13)(t=3.046,P<0.01),三支病变组SUA水平(465.66±100.41)明显高于双支病变组(388.95±87.21)、单支病变组(335.77±86.60)(t=4.342,P<0.01;t=7.405,P<0.01)。冠脉狭窄375%组SUA水平(406.07±100.56)明显高于<75%组(343.55±98.00)(t=3.770,P<0.01)。SUA诊断冠脉双支病变的ROC曲线下面积为0.764(95%CI为0.663~0.865),诊断3支病变的ROC曲线下面积为0.918(95%CI为0.852~0.984)。Logistic多因素回归分析结果显示:高血压病史、糖尿病史、吸烟史、血尿酸为冠心病发病的独立危险因素。结论SUA在冠状动脉病变程度的诊断中具有一定价值,可为临床上CHD病情评估提供参考意义。

Objective To analyze the level of serum uric acid (SUA) in patients with coronary atherosclerotic heart disease (CHD), and to investigate the value of SUA in diagnosing the severity of coronary artery. Methods A total of 200 patients with CAG examination were collected from our hospital, including 18 patients without coronary artery disease (the control group) and 182 patients with coronary artery disease (the observation group) by CAG results. According to the number of diseased coronary arteries, patients in the observation group were divided into three subgroups: the single-vessel lesion group (n =68), the double-vessel lesion group (n =67) and the three-vessel lesion group (n =47). Patients in the observation group were divided into subgroups, according to whether the degree of coronary artery stenosis exceeded 75%(at least one of the diseased vessels was qualified). The differences of SUA between the two groups and subgroups were compared, and the receiver operating characteristic (ROC) curve of SUA in diagnosing the number of coronary artery lesions was plotted. Results The level of SUA (388.89 ±103.45) in the observation group was higher than that in the control group (313.53 ±53.13)(t =3.046, P <0.01). The levels of SUA (465.66 ±100.41) in the threevessel lesion group were higher than those in the double-vessel lesion group (388.95 ±87.21) and the single-vessel lesion group (335.77 ±86.60)(t =4.342, P <0.01, t = 7.405, P <0.01). The level of SUA (406.07 ±100.56) in the (≥75%) stenosis group was higher than that in the (<75%) stenosis group (343.55 ±98.00). The area under the ROC curve of SUA was 0.764 in the diagnosis of double-vessel lesion (95% CI: 0.663 ~0.865), and the area under the ROC curve was 0.918 (95% CI: 0.852 ~ 0.984) in the diagnosis of three-vessel lesion. Logistic multivariate regression analysis showed that the history of hypertension, diabetes, smoking and serum uric acid were independent risk factors for CHD. Conclusion SUA has a certain value in the diagnosis of the degree of CHD, and can provide reference significance for the clinical evaluation of CHD.