高原地区血尿酸水平与慢性心力衰竭的相关性研究

To analyze the relationship between serum uric acid and chronic heart failure in plateau area

目的分析高原地区慢性心功能不全患者血尿酸水平与心力衰竭发生风险的相关性。方法选取2015年6月至2016年6月拉萨市人民医院慢性心功能不全患者121例,依据临床症状,按纽约心脏协会(New York HeartAssociation,NYHA)心功能分级分为非心力衰竭组(70例)与心力衰竭组(51例),比较两组血尿酸及年龄、血脂、同型半胱氨酸(homocysteine,Hcy)等指标,采用多因素logistic回归分析血尿酸与慢性心力衰竭的关系,并绘制ROC曲线评估尿酸水平对心力衰竭的预测价值。结果与非心力衰竭组相比,心力衰竭组患者平均年龄更高、心率增快、血尿酸及Hcy水平升高,差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄(OR=1.059,95%CI:1.016~1.105,P=0.007)、血尿酸(OR=1.008,95%CI:1.003~1.012,P=0.001)为高原地区心力衰竭的预测因子。ROC曲线显示,年龄与尿酸联合预测心力衰竭的敏感度为64.0%,特异度为83.6%,AUC为0.837(95%CI:0.764~0.909,P<0.001)。进一步按照年龄≤60岁和?60岁、血尿酸水平≤400μmol/L和?400μmol/L进行分层后,logistic回归分析显示,年龄?60岁的OR值为8.27(95%CI:2.53~27.11,P<0.001),血尿酸>400μmol/L的OR值为17.37(95%CI:5.40~55.92,P<0.001)。结论高原地区慢性心力衰竭患者血尿酸水平要高于非心力衰竭患者,高尿酸血症可增加心力衰竭的风险。

Objective To analyze the correlation between the level of serum uric acid and the risk of heart failure in patients with chronic cardiac insufficiency in plateau area.Methods One hundred and twenty-one patients with chronic cardiac insufficiency in Tibet were divided into non-heart failure group(n=70)and heart failure group(n=51)according to NYHA classification.The differences of serum uric acid,age,blood lipid and Hcy between the two groups were compared.The relationship between serum uric acid and chronic heart failure was analyzed by multivariate logistic regression,and ROC curve was drawn to evaluate the predictive value of uric acid level in heart failure.Results Compared with the non-heart failure group,the average age,heart rate,BNP,serum uric acid and blood Hcy levels in the heart failure group were significantly higher.The results of logistic regression analysis showed that age(OR=1.059,95%CI:1.016-1.105)and serum uric acid(OR=1.008,95%CI:1.003-1.012)might be prediction factors of heart failure.By drawing ROC curve,it was found that the sensitivity and specificity of combined prediction of age and serum uric acid level in heart failure were 64.0%and 83.6%respectively(95%CI:0.764-0.909,P<0.001).After further stratification according to age and serum uric acid level,logistic regression analysis showed that the OR value of patients age>60 years old was 8.27(95%CI:2.53-27.11,P<0.001),and the OR of serum uric acid>400μmol/L was 17.37(95%CI:5.40-55.92,P<0.001).Conclusions The level of serum uric acid in patients with chronic heart failure is higher than that in patients without heart failure and hyperuricemia can increase the risk of heart failure in plateau area.