血清尿酸水平与缺血性脑梗死静脉溶栓患者短期预后的研究

Serum uric acid and short term prognosis of acute ischemic stroke in patients received intravenous thrombolysis

目的探讨接受静脉溶栓治疗的急性缺血性脑卒中患者血清尿酸水平与神经功能恢复和短期预后结局的关系。方法前瞻性纳入了2017年1月1日至2019年12月31日在徐州医科大学附属连云港医院接受静脉溶栓治疗的急性缺血性脑卒中患者386例。应用美国国立卫生研究院卒中评分量表(NIHSS)评估卒中严重程度。根据出院时、出院后3个月的改良Rankin量表评分判断预后结局。采用Pearson相关分析法探究基线和出院时的NIHSS评分和血清尿酸水平的关系。采用倾向性评分匹配的方法以均衡混杂因素, 应用多变量logistic回归分析评估血清尿酸对卒中结局的影响。结果共纳入386例患者, 其中230例(59.6%)在3个月后随访时预后结局良好。血清尿酸水平与出院时NIHSS评分呈负相关(r=-0.171,P=0.003), 与住院期间NIHSS差值呈正相关(r=0.118,P=0.032)。根据尿酸水平的三分位数分为3组, 多变量logistic回归模型分析显示, 较高的血清尿酸水平是卒中3个月预后良好的独立预测因素(OR=0.421, 95%CI 0.327~0.541,P<0.001)。结论在接受静脉溶栓治疗的急性缺血性卒中患者中, 血清尿酸水平较高的患者有相对更好的神经功能恢复和更佳的短期预后。

Objective To investigate the relationship between serum uric acid(SUA)and 3-month outcomes in patients with acute ischemic stroke undergoing intravenous thrombolysis.Methods A total of 386 patients with acute ischemic stroke received intravenous thrombolysis therapy from 1 January 2017 to 31 December 2019 in the Affiliated Hospital of Lianyungang,Xuzhou Medical University were enrolled prospectively.The National Institute of Health Stroke Scale(NIHSS)was used to evaluate the severity of stroke.The functional outcome was evaluated by the modified Rankin Scale at discharge or 3 months after onset.Pearson′s correlation was used to assess the relationship between SUA and NIHSS scores at baseline and discharge.Propensity score matching was used to balance confounding factors.Multivariate logistic regression model was used to identify the correlation between SUA and prognostic outcome after thrombolysis.Results A total of 386 eligible patients were included.Two hundred and thirty patients(59.6%)had good outcomes in the follow-up after 3 months.The levels of SUA are negatively associated with the NIHSS score at discharge(r=-0.171,P=0.003).A positive correlation was observed between the levels of SUA and the difference of NIHSS at baseline and discharge(r=0.118,P=0.032).Patients were divided into three groups according to the quartile of SUA.Multivariate logistic regression analysis showed that high SUA levels were independently associated with good outcome three months after stroke(OR=0.421,95%CI 0.327-0.541,P<0.001).Conclusion In patients with acute ischemic stroke,elevated SUA levels can predict better recovery and short-term outcomes in patients undergoing intravenous thrombolysis.