降尿酸治疗对脑梗死患者血管内皮功能的影响

Effect of hyperuricemia treatment on vascular endothelial function in patients with cerebral infarction

目的研究高尿酸血症的急性脑梗死患者降尿酸治疗对血管内皮功能及血压的影响。方法搜集同一中心共138例患者入选该研究。高尿酸血症并急性脑梗死者入选92例,随机(随机数字法)分为实验组46例,对照组46例,同时入选同期血尿酸正常的急性脑梗死患者46例,实验组口服别嘌醇3个月治疗高尿酸血症。对这些人群进行抽血化验,记录治疗前后血尿酸、血脂及hs-CRP,同时检测患者血压、体质量指数(BM1),并采用超声无创血流介导的血管舒张功能(FMD)进行血管内皮功能评估,治疗前后各组之间比较并进行统计学分析。结果别嘌醇治疗3个月后实验组血尿酸[(479.7±49.0)μ mol/L vs.(381.2±76.7)μmol/L]、hs-CRP[(8.1±6.7)mg/L vs.(5.1±4.6)mg/L]、收缩压[(124.7±26.3)mmHg vs.(97.4±13.5)mmHg]明显降低(P<0.05),FMD[(7.6±3.5%)(11.2±3.9%)]明显升高(P<0.05),FMD升高的程度与血尿酸降低的程度呈正相关(r=0.463,P<0.01),多元回归分析显示血尿酸是FMD的独立影响因子(β=-0.229,P=0.035)。结论高尿酸血症的急性脑梗死患者中降尿酸治疗可明显改善患者的血管内皮功能,改善炎症状态,降低患者血压,进一步印证了高尿酸血症导致血管内皮功能紊乱,促进动脉粥样硬化的发生与发展。

Objective To investigate the effect of hyperuricemia treatment on vascular endothelial function and blood pressure in patients with acute cerebral infarction.Methods A total of 138 cases from the same center were enrolled in the study.92 cases of acute cerebral infarction patients combined with hyperuricemia were selected.They were randomly divided into the experimental group(46 cases)and control group(46 cases).46 cases of acute cerebral infarction patients with normal uric acid were selected in the same period.Patients in the experimental group received oral allopurinol for 3 months to treat hyperuricemia.Serum uric acid,blood lipid,and hs-CRP were tested before and after treatment in these populations.Blood pressure and body mass index(BMI)were also detected,and vascular endothelial function was evaluated using ultrasound non-invasive blood flow mediated vasodilation function(FMD).Comparison and statistical analysis were carried out in groups.Results Uric acid[(479.7±49.0)μmol/L vs.(381.2±76.7)μmol/L]、hs-CRP[(8.1±6.7)mg/L(5.1±4.6)mg/L]、systolic blood pressure[(124.7±26.3)mmHg vs.(97.4±13.5)mmHg]decreased significantly in the experimental group after 3 months of treatment with allopurinol(P<0.05),and blood flow mediated vasodilation function[(7.6±3.5)vs.(11.2±3.9)]significantly increased(P<0.05).The decrease of serum uric acid was positively correlated with the increase of FMD in the experimental group(r=0.463,P<0.01).Multiple Regression analysis showed that serum uric acid was an independent predictor of FMD(β=-0.229,P=0.035).Conclusions The treatment of hyperuricemia in patients with acute cerebral infarction can significantly improve the vascular endothelial function of patients,improve inflammation state and lower blood pressure.It is further confirmed that a higher uric acid level is related to worse endothelial function which may contribute to atherosclerosis.