血清尿酸预测急性缺血性卒中患者静脉溶栓后转归

Serum uric acid predicts outcomes after intravenous thrombolysis in patients with acute ischemic stroke

目的探讨血清尿酸(serum uric acid,SUA)与急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓后短期临床转归的相关性及预测价值。方法回顾性纳入2018年7月1日至2022年3月31日在南京医科大学康达学院第一附属医院接受静脉溶栓的AIS患者。检测入院后次日上午空腹SUA、血糖和血脂等指标。出院时采用改良Rankin量表评价功能转归情况,0~2分定义为转归良好,3~6分定义为转归不良。应用多变量logistic回归分析确定AIS患者静脉溶栓后短期转归不良的独立危险因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线评价SUA对静脉溶栓后短期转归不良的预测价值。结果研究期间共纳入291例患者。其中,男性197例(67.70%),年龄(65.02±11.56)岁。中位基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分为5分(四分位数间距3~11分),SUA为(322.06±90.54)μmol/L。单变量分析显示,转归不良组年龄、心房颤动和心源性栓塞的患者构成比以及基线空腹血糖和NIHSS评分显著高于转归良好组,而静脉溶栓后SUA显著低于转归良好组(P均<0.05)。多变量logistic回归分析显示,较高的SUA与转归良好相关[优势比(odds ratio,OR)0.986,95%置信区间(confidence interval,CI)0.985~0.991;P<0.01],而较高的年龄(OR 1.047,95%CI 1.021~1.075;P<0.01)和基线NIHSS评分(OR 1.155,95%CI 1.063~1.254;P<0.01)与转归不良独立相关。ROC曲线分析显示,SUA预测转归不良的曲线下面积为0.642(95%CI 0.552~0.732;P=0.002),最佳截断值为307.45μmol/L,预测敏感性和特异性分别为57.7%和68.0%。结论较高的SUA与AIS患者静脉溶栓治疗后短期转归良好相关,但其预测转归的价值有限。

Objective To investigate the correlation and predictive value of serum uric acid(SUA)and short-term clinical outcomes after intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods Patients with AIS received intravenous thrombolysis in the First Affiliated Hospital of Kangda College of Nanjing Medical University from July 1,2018 to March 31,2022 were retrospectively enrolled.Fasting SUA,blood glucose and blood lipids were measured the next morning after admission.The modified Rankin Scale was used to evaluate the functional outcome at discharge.0-2 points were defined as good outcome,and 3-6 points were defined as poor outcome.Multivariate logistic regression analysis was used to determine the independent risk factors for poor short-term outcome in patients with AIS after intravenous thrombolysis.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of SUA for poor short-term outcome after intravenous thrombolysis.Results A total of 291 patients were enrolled during the study.Among them,197(67.70%)were male,aged 65.02±11.56 years.The median baseline National Institutes of Health Stroke Scale(NIHSS)score was 5(interquartile range 3-11),and the SUA was 322.06±90.54µmol/L.Univariate analysis showed that the age,proportions of patients with atrial fibrillation and cardiogenic embolism,baseline fasting blood glucose and NIHSS scores in the poor outcome group were significantly higher than those in the good outcome group,while the SUA after intravenous thrombolysis was significantly lower than that in the good outcome group(all P<0.05).Multivariable logistic regression analysis showed that higher SUA was independently associated with the good outcomes(odds ratio[OR]0.986,95%confidence interval[CI]0.985-0.991;P<0.01),while older age(OR 1.047,95%CI 1.021-1.075;P<0.01)and baseline NIHSS score(OR 1.155,95%CI 1.063-1.254;P<0.01)were independently associated with the poor outcomes.ROC curve analysis showed that the area under the curve of poor outcome predicted by SUA was 0.642(95%CI 0.552-0.732;P=0.002),the best cutoff value was 307.45µmol/L,and the sensitivity and specificity of prediction were 57.7%and 68.0%respectively.Conclusion Higher SUA is associated with the short-term outcome of patients with AIS after intravenous thrombolytic therapy,but its predictive value of the outcomes is limited.