尿酸与白蛋白比值对心力衰竭患者预后的临床价值研究

Clinical value of uric acid-to-albumin ratio on prognosis of patients with heart failure

目的 研究尿酸与白蛋白比值(UAR)对预测心力衰竭患者预后的临床价值。方法 选取中国心力衰竭数据库中临床资料完整的1 893例心力衰竭患者作为研究对象进行回顾性队列研究分析。收集研究对象的一般临床资料、凝血常规、心肌肌钙蛋白I(cTnI)、心肌酶谱、肝功能、B型利钠肽(BNP)、尿酸(UA)、白蛋白(ALB)及超声心动图下左心室射血分数,计算UAR。根据受试者工作特征(ROC)曲线选取UAR最佳截断值为17.48,将患者分为低UAR组(UAR<17.48,n=1 525)和高UAR组(UAR≥17.48,n=368)。对两组临床资料进行比较,采用二元logistic回归分析评估UAR对心力衰竭患者全因死亡事件的影响。结果 患者随访时间为90 d,随访期间共发生全因死亡37例(2.0%)。高UAR组男性比例、心功能Ⅳ级比例、心肌梗死比例、UA、D-二聚体、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、ALT、谷氨酰转肽酶(GGT)、碱性磷酸酶(AKP)、BNP水平高于低UAR组,脉搏、收缩压、舒张压、心功能Ⅱ级和Ⅲ级比例、ALB水平低于低UAR组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,UAR评估心力衰竭发生全因死亡的曲线下面积为0.715(95%CI:0.626~0.804,P<0.001),灵敏度56.8%,特异度81.4%;二元logistic回归分析结果显示,高UAR组全因死亡发生率是低UAR组1.09倍(OR=1.09,95%CI:1.02~1.20,P=0.017)。结论 UAR可作为心力衰竭发生全因死亡的独立预测因素,临床需加以重视。

Objective To investigate the clinical value of uric acid(UA) to albumin(Alb) ratio(UAR) in predicting the prognosis of the patients with heart failure.Methods A total of 1 893 patients with heart failure and complete clinical data in the Chinese Heart Failure Database were selected as the clinical research subjects for conducting the retrospective cohort analysis.The general clinical data,coagulation routine,troponin I(cTnI),cardiac enzyme profile,liver function,B-type brain natriuretic peptide(BNP),uric acid(UA) and left ventricular ejection fraction in echocardiography in the study subjects were collected to calculate UAR.According to the receiver operating characteristic(ROC) curve,the optimal cut-off value of UAR was selected as 17.48.Then the subjects were divided into the low UAR group(UAR<17.48,n=1 525) and high UAR group(UAR≥17.48,n=368).The clinical data were compared between the two groups,and the effect of UAR on the all-cause mortality in the patients with heart failure was evaluated by the binary logistic regression analysis.Results The follow up time in the patients was 90 d,and 37 cases(2.0%) of all-cause death occurred during the follow up period.The proportion of males,proportion of cardiac function grade Ⅳ,proportion of myocardial infarction,levels of uric acid,D-dimer,creatine kinase(CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),alanine aminotransferase(ALT),glutamyl transpeptidase(GGT),alkaline phosphatase(AKP) and BNP in the high UAR group were higher than those in the low UAR group,while the pulse,systolic pressure,diastolic pressure,proportions of heart function grade Ⅱand grade Ⅲ and ALB level were lower than those in the UAR group,and the differences were statistically significant(P<0.05).The ROC curve analysis results showed that the area under the curve of UAR for assessing the all-cause death occurrence in heart failure was 0.715(95%CI:0.626-0.804,P<0.001),the sensitivity was 56.8% and the specificity was 81.4%;the binary logistic regression analysis results showed that the incidence rate of all-cause mortality in the high UAR group was 1.09 times higher than that in the low UAR group(OR=1.09,95%CI:1.02-1.20,P=0.017).Conclusion UAR could serve as an independent predictive factor of all-cause death occurrence in heart failure,which needs clinic to pay attention.