高尿酸血症对无保护左主干冠心病患者长期预后的影响

Influence of hyperuricacidemia on long-term prognosis in patients with coronary heart disease of unprotected left main coronary artery lesions

目的研究血尿酸水平对无保护左主干病变的冠状动脉粥样硬化性心脏病(冠心病)患者预后的影响。方法入选2011年1月至2016年7月行经皮冠状动脉介入术(PCI)或冠状动脉旁路移植术(CABG)治疗的无保护左主干病变的冠心病患者881例,记录患者术前血尿酸基线水平,根据血尿酸水平分为高尿酸组(n=196)和正常尿酸组(n=685)。从手术结束后第1 d开始随访,平均随访时间5.1年。采用独立样本t检验或χ^(2)检验进行两组间基线资料的对比,采用单因素和多因素COX比例风险模型预测心血管不良联合终点事件(MACCE),包括全因死亡、非致命性心肌梗死、卒中及再次血运重建等发生的危险因素及保护因素,采用Kaplan-Meier法比较两组患者MACCE事件的差异。结果与正常尿酸组相比,高尿酸组患者的高脂血症、高血压病、脑血管病和血肌酐水平明显增高(P<0.05)。COX风险比例模型显示,校正前高尿酸组患者的MACCE发生率升高(HR=1.547,95%CI:1.19~2.01,P=0.001),多因素校正后显示高尿酸、高脂血症是MACCE发生率的独立危险预测因素,危险比分别为(HR=1.387,95%CI:1.06~1.82,P=0.017)和(HR=1.315,95%CI:1.03~1.68,P=0.027),而左室射血分数是MACCE发生率的独立保护因素(HR=0.983,95%CI:0.97~0.99,P=0.002)。Kaplan-Meier曲线显示高尿酸组患者累积事件包括全因死亡、非致死性心肌梗死、卒中及再次血运重建的联合终点发生率要高于正常尿酸组患者(log-rankχ^(2)=10.78,P=0.001)。结论高血尿酸水平与冠心病无保护左主干病变患者的不良预后具有一定相关性,对于冠心病无保护左主干病变患者,应该更严格的控制其尿酸水平。

Objective To study the influence of blood uric acid(BUA)on prognosis in patients with coronary heart disease of unprotected left main coronary artery lesions(CHD-ULM).Methods The patients(n=881)with CHD-ULM undergone percutaneous coronary intervention(PCI)or coronary artery bypass grafting(CABG)were chosen from Jan.2011 to July 2016,and baseline BUA level were recorded before the operation.All patients were divided into high BUA group(n=196)and normal BUA group(n=685).The patients were followed up on the first day after the operation,and mean follow-up period was 5.1 y.The baseline materials were compared between 2 groups by using independent-sample t test orχ^(2) test.The risk factors and protective factors of major adverse cardiovascular and cerebrovascular events(MACCE,including all-cause mortality,non-fatal myocardial infarction,stroke and re-revascularization)were predicted by using single-factor and multi-factor COX proportional hazard model.The difference in MACCE was compared between 2 groups by using Kaplan-Meier method.Results The percentages of cases of hyperlipidemia,hypertension and cerebral artery disease and level of serum creatinine(SCr)increased significantly in high BUA group compared with normal BUA group(P<0.05).The results of COX risk proportion model analysis showed that incidence rate of MACCE increased in high BUA group before correcting(HR=1.547,95%CI:1.19~2.01,P=0.001).The results of multi-factor correcting showed that hyperuricacidemia(HR=1.387,95%CI:1.06-1.82,P=0.017)and hyperlipidemia(HR=1.315,95%CI:1.03~1.68,P=0.027)were independent risk predictive factors of MACCE incidence,while left ventricular ejection fraction(LVEF)was a dependent protective factor of MACCE incidence(HR=0.983,95%CI:0.97~0.99,P=0.002).The results of Kaplan-Meier curve analysis showed that MACCE incidence rates,including all-cause mortality,non-fatal myocardial infarction,stroke and re-revascularization were higher in high BUA group than those in normal BUA group(log-rankχ^(2)=10.78,P=0.001).Conclusion There is a correlation between high BUA and poor prognosis in patients with CHD-ULM,and BUA level should be more strictly controlled in the patients.