青年人群累积尿酸暴露对早发缺血性卒中的影响

Effect of cumulative serum uric acid exposure on early-onset ischemic stroke in young adults

目的探究青年人群累积尿酸暴露量(cumSUA)对早发缺血性卒中的影响。方法采用前瞻性队列研究,选择首次参加2006年度和2008年度健康体检后,至2014年前,至少参与2次健康体检,且于末次体检时年龄<45岁的开滦职工作为观察对象,最终共纳入15607人,计算随访期间cumSUA,并根据cumSUA的三分位数将观察对象分为3组:第1组:cumSUA<1563μmol/L·年;第2组:1563μmol/L·年≤cumSUA<1996μmol/L·年;第3组:cumSUA≥1996μmol/L·年。以完成末次体检的时间为随访起点,以早发缺血性卒中为终点事件。选择Kaplan-Meier法计算cumSUA三分位分组间的早发缺血性卒中事件的累积发病率,并通过Log-rank法比较在不同分组间累积发病率的差异。采用多因素Cox回归模型分析cumSUA三分位分组间发生早发缺血性卒中事件的风险。采用4节点(第5、25、75、95百分位数)限制性立方样条图评估cumSUA与早发缺血性卒中事件的剂量-反应关系。结果15607名观察对象,平均随访(7.3±1.1)年,发生早发缺血性卒中事件100例,发病时平均年龄(46±4)岁,第1、2、3组的事件发生例数分别为18例、35例、47例,第1、2、3组的累积发病率分别为0.40%、0.77%、1.07%。通过Log-rank检验,各组间结局事件累积发病率的差异有统计学意义(χ^(2)=14.96,P=0.003),Cox回归分析结果显示,校正混杂因素后,与第1组相比,第2、3组发生早发缺血性卒中的HR值(95%CI)分别为[1.67(0.92,3.00),P=0.090;2.05(1.483.69),P=0.020]。限制性立方样条结果显示,在校正混杂因素后,cumSUA与早发缺血性卒中呈非线性相关。结论cumSUA与青年早发缺血性卒中的发病风险呈正向关联。

Objective To investigate the effect of cumulative serum uric acid(cumSUA)on early-onset ischemic stroke in young adults.Methods A prospective cohort study was conducted.A total of 15607 Kailuan workers who participated in at least two physical check-ups in 2006 and 2008 and at the time of the last physical check-up before 2014 were selected as subjects.Cumulative uric acid exposure during the followup period was calculated.The subjects were divided into three groups according to the quantile of cumSUA:the first quantile group was cumSUA<1563μmol/Lyear,the second quantile group was:1563μmol/L·year≤cumSUA<1996μmol/L·year,the third group was cumSUA≥1996μmol/L·year.The time of the last physical check-up was regarded as the starting point of follow-up,and early-onset ischemic stroke was regarded as the end event.Kaplan-Meier was used to calculate the incidence of early-onset ischemic stroke in different groups,and Log-rank method was used to calculate the differences in the incidence of early-onset ischemic stroke among different groups.Multivariate Cox regression model was used to analyze the risk of early-onset ischemic stroke in different groups.A four-node(5th,25th,75th,95th percentile)restricted cubic spline plot was used to assess the dose-response relationship between cumSUA and early-onset ischemic stroke.Results A total of 15607 subjects were followed up for(7.3±1.1)years.100 cases with early-onset ischemic stroke were observed with an average age of(46±4)years old.The number of events in the first,second,and third quartile groups was 18,35,and 47,respectively,and the cumulative incidence rates in the first,second,and third quartile groups were 0.40%,0.77%,and 1.07%,respectively.The difference in cumulative incidence of endpoint events between the groups was statistically significant by Log-rank test(χ^(2)=14.96,P=0.003).The results of Cox regression analysis showed that after correcting for confounders,the HR(95%CI)for early-onset ischemic stroke in the second and third quartile groups was[1.67(0.92,3.00),P=0.090;2.05(1.48,3.69),P=0.020].Restricted cubic spline results showed a nonlinear correlation between cumSUA and early-onset ischemic stroke after adjysted for confounders.Conclusion Cumulative serum uric acid is positively correlated with the risk of early-onset ischemic stroke in young adults.