高尿酸血症与冠状动脉旁路移植术后患者不良事件的相关性研究

Association of hyperuricemia with major adverse events following coronary artery bypass grafting

目的研究冠状动脉旁路移植术(coronary artery bypass grafting,CABG)患者术后早期高尿酸血症与主要不良心脑血管事件(major cardiac and cerebrovascular events,MACCE)的相关性。方法回顾性分析2016年1月至2019年12月于中国医学科学院阜外心血管病医院接受CABG治疗的174例成人患者的临床资料。根据CABG术后是否发生高尿酸血症分组,87例术后高尿酸血症患者为研究组,87例术后尿酸正常患者为对照组。采用Cox多因素回归分析CABG术后3年内发生MACCE的高危因素。结果研究组CABG术后3年内发生MACCE的患者比例(26.4%)高于对照组(6.9%),差异有显著性(P=0.001)。Cox多因素回归分析表明,CABG术后高尿酸血症患者术后3年内发生MACCE的风险为尿酸正常患者的6.82倍(95%CI 2.39~19.46,P<0.001)。CABG术后高尿酸血症预测MACCE的敏感性为79.3%(95%CI 63.6%~95.0%),特异性为55.9%(95%CI 47.7%~64.0%),阳性预测值为26.4%(95%CI 17.0%~35.9%),阴性预测值为93.1%(95%CI 87.7%~98.5%)。结论CABG术后早期高尿酸血症可预测患者术后3年内MACCE的发生风险。对CABG术后早期发生高尿酸血症的患者应进行密切监测。

Objective To evaluate the association of postoperative early-state hyperuricemia with major cardiac and cerebrovascular events(MACCE)in adult patients after coronary artery bypass grafting(CABG).Method The clinical data of 174 patients,who underwent CABG and were followed up at Fuwai Hospital from January 2016 to December 2019,were retrospectively analyzed.Grouped according to postoperative hyperuricemia status,87 CABG patients with postoperative hyperuricemia were analyzed as study group,and 87 CABG patients with normal postoperative uric acid levels as control group.Cox regression analysis was used to evaluate the risk factors associated with MACCE during follow-up.Result The proportion of MACCE in the hyperuricemia group was significantly higher(26.4%vs 6.9%,P=0.001).In the multivariable COX regression analysis,postoperative hyperuricemia(hazard ratio 6.82,95%CI 2.39-19.46,P<0.001)was positively associated with MACCE within three years after CABG.Sensitivity for detecting MACCE with postoperative hyperuricemia was 79.3%(95%CI 63.6%-95.0%),specificity 55.9%(95%CI 47.7%-64.0%),positive predictive value 26.4%(95%CI 17.0%-35.9%),and negative predictive value 93.1%(95%CI 87.7%-98.5%).Conclusions Postoperative hyperuricemia can predict MACCE within three years after CABG.Patients with postoperative hyperuricemia might require to be closely monitored.