不同尿酸水平的冠心病患者临床特征及其预后的影响因素分析

Analysis of clinical features and prognostic factors in patients with coronary heart disease with different uric acid levels

目的分析不同尿酸水平的冠心病患者临床特征及其预后的影响因素。方法回顾性选择2020年1月至2022年6月牡丹江心血管病医院接诊的150例冠心病患者作为研究对象,根据尿酸水平不同进行分组,分为高尿酸血症组(n=38)和正常尿酸组(n=112)。比较两组的冠状动脉病变部位、支数、Gensini积分、冠状动脉斑块面积、斑块最大厚度、斑块纤维帽厚度;随访12个月,记录主要不良心血管事件的发生情况,使用单因素及多因素COX回归分析冠心病患者发生主要不良心血管事件的影响因素;采用受试者工作特征(ROC)曲线分析血清尿酸对主要不良心血管事件的预测效能。结果两组冠状动脉左前降支病变率、左主干病变率比较,差异均无统计学意义(P>0.05);高尿酸血症组冠状动脉左回旋支病变率、右冠状动脉病变率分别为60.53%、60.53%,均高于正常尿酸组(41.07%、41.96%),差异均有统计学意义(P<0.05)。高尿酸血症组冠状动脉病变支数为(2.12±0.84)支,多于正常尿酸组[(1.75±0.73)支],Gensini积分为(51.25±14.78)分,高于正常尿酸组[(41.98±10.03)分],差异均有统计学意义(P<0.05)。高尿酸血症组冠状动脉斑块面积、斑块最大厚度分别为(14.78±1.15)mm^(2)、(2.26±0.31)mm,均大于正常尿酸组[(8.26±0.49)mm^(2)、(1.44±0.18)mm],斑块纤维帽厚度为(0.45±0.13)mm,小于正常尿酸组[(0.86±0.27)mm],差异均有统计学意义(P<0.05)。经单因素及多因素COX回归分析,高脂血症、多支病变、尿酸均是冠心病患者发生主要不良心血管事件的独立影响因素(P<0.05)。经ROC曲线分析,血清尿酸预测冠心病患者发生主要不良心血管事件的敏感度为84.76%,特异度为53.89%,曲线下面积为0.923。结论血清尿酸水平与冠心病患者的冠状动脉病变严重程度密切相关,高脂血症、高尿酸血症、多支病变均是患者发生主要不良心血管事件的独立影响因素,值得临床予以重视。

Objective To analyze the clinical features and prognostic factors of coronary heart disease patients with different uric acid levels.Methods A total of 150 patients with coronary heart disease admitted to Mudanjiang Cardiovascular Hospital from January 2020 to June 2022 were retrospectively selected as the study objects,and divided into hyperuricemia group and normal uric acid group according to the different uric acid level.The lesion site,number,Gensini score,coronary plaque area,maximum plaque thickness and plaque fiber cap thickness were compared between the two groups.The incidence of major adverse cardiovascular events was recorded during 12 months of follow-up.Univariate and multivariate COX regression were used to analyze the influencing factors of major adverse cardiovascular events in patients with coronary heart disease.The predictive efficacy of serum uric acid on major adverse cardiovascular events was analyzed by receiver operating characteristic(ROC)curve.Results There were no statistically significant differences in the lesion rates of left anterior descending branch and left main coronary artery between the two groups(P>0.05).The lesion rates of left circumflex artery and right coronary artery in hyperuricemia group were 60.53%and 60.53%,respectively,which were higher than those in the normal uric acid group(41.07%and 41.96%),and the differences were statistically significant(P<0.05).The number of coronary artery lesions in hyperuricemia group was(2.12±0.84),which was higher than that in the normal uric acid group[(1.75±0.73)],and Gensini score was(51.25±14.78)points,which was higher than that in the normal uric acid group[(41.98±10.03)points],and the differences were statistically significant(P<0.05).The coronary plaque area and maximum plaque thickness in hyperuricemia group were(14.78±1.15)mm^(2),(2.26±0.31)mm,respectively,which were larger than those in the normal uric acid group[(8.26±0.49)mm^(2),(1.44±0.18)mm],the thickness of the fibrous cap of the plaques was(0.45±0.13)mm,which was smaller than that in the normal uric acid group[(0.86±0.27)mm],and the differences were statistically significant(P<0.05).Through univariate and multifactorial COX regression analysis,hyperlipidemia,multi-vessel disease and uric acid were independent influencing factors for major adverse cardiovascular events in CHD patients(P<0.05).ROC curve analysis showed that the sensitivity,specificity and area under the curve of serum uric acid to predict the occurrence of major adverse cardiovascular events in CHD patients were 84.76%,53.89%and 0.923.Conclusion Serum uric acid level is closely related to the severity of coronary artery disease in patients with coronary heart disease,hyperlipidemia,high uric acid hematic disease and multi-vessel disease are independent factors affecting the occurrence of major adverse cardiovascular events in patients,which deserves clinical attention.