尿酸对慢性心力衰竭合并心房颤动的老年患者心功能及远期预后的相关关系

Correlation of uric acid with cardiac function and long-term prognosis in elderly chronic heart failure patients with concomitant AF

目的探讨尿酸对慢性心力衰竭(心衰)合并心房颤动(房颤)的老年患者心功能及远期预后的相关关系。方法采用回顾性队列研究,连续纳入2018年8月至2020年8月在河北省人民医院心血管内科住院的老年慢性心衰合并房颤患者324例,根据尿酸水平,将患者分为高尿酸组150例和正常尿酸组174例。收集各组临床资料、实验室检查及超声心电图指标,出院后随访3年,研究终点为主要不良心血管事件。结果单因素方差分析显示,纽约心功能分级Ⅳ级的患者尿酸水平显著高于心功能Ⅱ级、Ⅲ级[(445.39±184.54)μmol/L vs(378.86±122.64)μmol/L、(403.50±142.15)μmol/L,P<0.05)]。多因素Cox分析显示,年龄(95%CI:1.012~1.075,P=0.007)、尿酸水平(95%CI:1.000~1.004,P=0.048)、他汀类药物(95%CI:0.215~0.721,P=0.003)与心脏性死亡风险显著相关。结论尿酸与慢性心衰合并房颤的老年患者长期预后有关,对远期发生心脏性死亡有一定预测价值。

Objective To investigate the relationship between uric acid(UA)and cardiac function as well as long-term prognosis in elderly patients with chronic heart failure(CHF)and concomi-tant atrial fibrillation(AF).Methods A retrospective cohort study was conducted on 324 consec-utively recruited elderly CHF patients with concomitant AF who were hospitalized in our depart-ment from August 2018 to August 2020.According to their UA level,they were divided into a high UA group(150 cases)and a normal UA group(174 cases).The clinical data,results of labo-ratory tests and echocardiogram indicators were collected.All patients were followed up for 3 years after discharge.The endpoint was major adverse cardiovascular events.Results U nivariate analysis of variance showed that the UA level was significantly higher in the patients with NYHA Class IV than those with Classes II and II(445.39±184.54μmol/L Us 378.86±122.64μmol/L and 403.50±142.15μmol/L,P<0.05).Multivariate Cox analysis indicated that age(95%CI:1.012-1.075,P=0.007),UA level(95%CI:1.000-1.004,P=0.048)and use of statins(95%CI:0.215-0.721,P=0.003)were significantly associated with the risk of cardiac death.Conclu-sion UA is associated with the long term prognosis of elderly CHF patients with concomitant AF,and has certain predictive value for long term cardiac death.