血清尿酸水平与急性缺血性卒中患者心率变异性的相关性

Correlation between serum uric acid level and heart rate variability in patients with acute ischemic stroke

目的探讨急性缺血性卒中患者血清尿酸水平与心率变异性(heart rate variability,HRV)的相关性。方法回顾性纳入2017年7月至2019年7月南京医科大学第一附属医院神经内科收治的急性缺血性卒中患者。按照性别特异性血清尿酸水平四分位数分为4组(Q1、Q2、Q3、Q4),比较各组之间人口统计学数据、基线临床资料、实验室指标以及24 h动态心电图记录的HRV时域参数。通过多元线性回归分析HRV时域参数RR(normal-to-normal,NN)间期标准差(standard deviation of the NN intervals,SDNN)以及RR间期均值标准差(standard deviation of the average NN intervals,SDANN)与血清尿酸水平的独立相关性。结果共141例患者纳入研究,男性100例(70.92%),年龄(61.55±12.92)岁,中位基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分为2分(四分位数间距:1~4分),血清尿酸水平为(302.87±73.48)μmol/L。血清尿酸水平四分位数组之间NIHSS评分(P<0.034)、高血压患者构成比(P=0.015)和估算肾小球滤过率(P<0.001)以及各项HRV时域参数(P均<0.001)差异均有统计学意义。血清尿酸水平最低四分位数组HRV低下(SDNN<100 ms)的患者构成比显著高于其他四分位数组(P<0.05)。多元线性回归分析显示,血清尿酸水平与SDNN(标准化β=0.321,P<0.001)以及SDANN(标准化β=0.266,P=0.001)呈显著独立正相关。结论急性缺血性卒中患者血清尿酸水平低下预示着HRV低下,可能提示急性缺血性卒中患者HRV降低存在氧化应激机制参与。

Objective To investigate the correlation between serum uric acid level and heart rate variability(HRV)in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to the Department of Neurology,the First Affiliated Hospital of Nanjing Medical University from July 2017 to July 2019 were enrolled retrospectively.They were divided into 4 groups(Q1,Q2,Q3,and Q4)according to the sex-specific serum uric acid quartiles.The demographic data,baseline clinical data,laboratory indicators and HRV recorded by 24-h dynamic electrocardiogram in each group were compared.The independent correlation between HRV time domain parameters RR(normal-to-normal,NN)interval standard deviation(standard deviation of the NN intervals,SDNN),RR interval mean standard deviation(standard deviation of the average NN intervals,SDANN)and serum uric acid level was analyzed through multiple linear regression model.Results A total of 141 patients were enrolled in the study,including 100 males(70.92%),aged 61.55±12.92 years.The median baseline National Institutes of Health Stroke Scale(NIHSS)score was 2(interquartile range:1-4),and the serum uric acid level was 302.87±73.48μmol/L.There were significant differences in the NIHSS score(P<0.034),the proportion of patients with hypertension(P=0.015),the estimated glomerular filtration rate(P<0.001),and the HRV time domain parameters(all P<0.001)between each quartile group.The proportion of patients with low HRV(SDNN<100 ms)in the lowest serum uric acid level quartile group was significantly higher than that in other quartile groups(P<0.05).Multiple linear regression analysis showed that serum uric acid levels were significantly and positively correlated with SDNN(standardizedβ=0.321,P<0.001)and SDANN(standardizedβ=0.266,P=0.001).Conclusions The low level of serum uric acid in patients with acute ischemic stroke indicates that HRV is low,which may suggest that the mechanism of oxidative stress is involved in the decrease of HRV in patients with acute ischemic stroke.