血清尿酸与血管内治疗的急性前循环缺血性卒中老年患者有症状颅内出血和转归的相关性

Correlation between serum uric acid level and symptomatic intracranial hemorrhage and outcomes in elderly patients with acute anterior circulation ischemic stroke treated with endovascular therapy

目的探讨血清尿酸水平与老年前循环急性缺血性卒中(acute ischemic stroke,AIS)患者血管内治疗(endovascular therapy,EVT)后有症状颅内出血(symptomatic intracranial hemorrhage,sICH)及转归的相关性。方法回顾性纳入2017年12月至2020年12月期间在北京老年医院和宣武医院接受EVT的老年(年龄≥65岁)AIS患者。sICH定义为入院72 h内复查CT显示脑实质出血且基线美国国立卫生研究院卒中量表评分较基线增加≥4分。在发病后90 d时通过改良Rankin量表进行临床转归评估,0~2分表示转归良好,3~6分表示转归不良。对sICH组与非sICH组以及转归良好组与转归不良组的临床资料进行比较。应用多变量logistic回归分析确定血清尿酸水平与sICH以及转归不良的独立相关性。结果共纳入122例患者,年龄(73.89±6.24)岁,73例(59.8%)为男性。52例(42.6%)出现出血性转化,27例(22.1%)出现sICH,28例(23.8%)发病后90 d时转归良好。sICH组血清尿酸显著低于非sICH组患者(P=0.002),而转归良好组与转归不良组血清尿酸相近(P=0.510)。多变量logistic分析显示,血清尿酸较低是sICH的独立危险因素(优势比0.994,95%置信区间0.990~0.998;P=0.011)。结论血清尿酸较低是老年AIS患者EVT后sICH的独立危险因素,但与转归无关。

Objective To investigate the correlation between serum uric acid level and symptomatic intracranial hemorrhage(sICH)and outcomes after endovascular therapy(EVT)in elderly patients with anterior circulation acute ischemic stroke(AIS).Methods Elderly patients with AIS(aged≥65 years)received EVT in Beijing Geriatric Hospital and Xuanwu Hospital from December 2017 to December 2020 were retrospectively enrolled.sICH was defined as cerebral parenchymal hemorrhage revealed by CT within 72 h after admission and the Naitonal Institutes of Health Stroke Scale score increased by≥4 compared with the baseline.At 90 d after onset,the clinical outcome was evaluated by the modified Rankin Scale.0-2 was a good outcome and 3-6 was a poor outcome.The clinical data of the sICH group and non-sICH group,as well as the good outcome group and poor outcome group were compared.Multivariate logistic regression analysis was used to determine the independent correlation between serum uric acid level and sICH and poor outcomes.Results A total of 122 patients were enrolled,their age was 73.89±6.24 years,and 73(59.8%)were male.Fifty-two patients(42.6%)had hemorrhagic transformation,27(22.1%)had sICH,and 28(23.8%)had a good outcome at 90 d after onset.The serum uric acid in the sICH group was significantly lower than that in the non-sICH group(P=0.002),while the serum uric acid in the good outcome group was similar to that in the poor outcome group(P=0.510).Multivariate logistic analysis showed that the lower serum uric acid was an independent risk factor for sICH(odds ratio 0.994,95%confidence interval 0.990-0.998;P=0.011).Conclusion The lower serum uric acid level was an independent risk factor for sICH after EVT in elderly patients with AIS,but it was not associated with the outcomes.