急性脑梗死静脉溶栓患者血清尿酸水平和临床短期预后的相关性研究

Correlation study of serum uric acid on short-term outcome in acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator

目的探讨急性脑梗死静脉溶栓患者血清中尿酸水平与其临床短期预后的相关性。方法选取2015-2018年在上海交通大学附属瑞金医院神经内科卒中单元进行rt-PA静脉溶栓的急性缺血性脑卒中患者122例,随访90天时改良Rankin(mRS)评分>2分定义为预后不良组,mRS评分≤2分定义为预后良好组,比较两组人口学资料(年龄、性别、高血压、糖尿病、心房颤动、饮酒、吸烟)、临床资料(美国国立卫生研究院卒中量表(NIHSS)、改良Rankin评分、发病到溶栓的时间)、实验室指标(尿酸、胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇)的水平。结果两组人口学资料(年龄、性别、高血压、糖尿病、饮酒、吸烟)、实验室指标(胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白)差异无统计学意义;两组心房颤动、溶栓前NIHSS评分、发病至溶栓时间、血清尿酸水平差异有统计学意义,采用Logistic逐步回归分析后发现尿酸水平高提示预后良好,为短期预后不良的保护因素。结论急性脑梗死静脉溶栓患者的良好预后可能与其较高的血清尿酸水平相关,通过对其水平的测定可以提示该患者溶栓后的预后。

ObjectiveTo investigate the changes of serum uric acid on short-term outcome in acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator.MethodsA total of 122 acute ischemic stroke patients treated with thrombolysis in our stroke unit from 2015 to 2018 was included.At 90 days,the scores of the modified Rankin Scale(mRS)>2 was defined as poor prognosis and the scores of mRS≤2 was defined as excellent outcome.The demographic data,clinical data,and laboratory parameters on adimission were prospectively collected.Stepwise Logistic regression moedels were used to analyze potential factors affecting the prognosis.The demographic data (age,sex,hypertension,diabetes mellitus,atrial fibrillation,drinking,smoking),clinical data (NIHSS,modified Rankin Scale,the time between onset and thrombolysis) and laboratory indicators (uric acid,cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol) were compared between the two groups.ResultsThe demographic data (age,sex,hypertension,diabetes mellitus,drinking,smoking) and laboratory indexes (cholesterol,triglyceride,low density lipoprotein,high density lipoprotein) were not significantly different between the two groups.Atrial fibrillation,the scale of NIHSS before thrombolysis,time from onset to thrombolysis and the level of serum uric acid were significantly different between the two groups.Logistic regression analysis revealed that high level of serum uric acid was related to excellent outcome.ConclusionIncreased serum uric level was associated with better prognosis in acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator.