不同心力衰竭亚型老年患者血清尿酸与预后的关系

Relationship between serum uric acid and prognosis in different subtypes of elderly patients with heart failure

背景血清尿酸(serum uric acid,sUA)与炎症和微血管功能障碍有关,对不同的心力衰竭分型可能有不同的影响。目的研究sUA水平与不同左心室射血分数心力衰竭亚型老年患者预后的关系。方法纳入2014年9月—2017年7月解放军总医院第一医学中心和苏州大学附属第一医院心血管内科住院的老年慢性心力衰竭患者,所有患者入院24 h内接受血清尿酸的检测。随访至2017年9月,以心血管死亡事件为终点事件,以多因素Cox回归模型评估sUA水平对预后的影响。结果1355例患者中位随访时间18个月,总体上心血管死亡事件发生率为6.8%(92例),射血分数减低的心力衰竭(heart failure with reduced ejection fraction,HFrEF)、射血分数中间值的心力衰竭(heart failure with mid-range ejection fraction,HFmrEF)和射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)三组心血管死亡事件发生率分别为13.9%(47例)、6.1%(24例)和3.4%(21例)。与低sUA组相比,高sUA组患者心血管死亡事件的发生风险更高(HR=2.141,95%CI:1.199~3.824,P=0.01)。亚组分析中,在HFrEF患者中,与低sUA组相比,高sUA组不良事件发生风险也升高(HR=4.151,95%CI:1.866~9.234,P<0.001);在HFmrEF患者中,高sUA组心血管死亡事件发生风险相较低sUA组同样升高(HR=4.724,95%CI:1.664~13.414,P=0.004)。结论sUA水平的升高与老年HFrEF和HFmrEF患者心血管不良预后相关。

Background Elevated serum uric acid(sUA)levels have been associated with poor outcome in patients with heart failure.Uric acid is associated with inflammation and microvascular dysfunction,which may differentially affect left ventricular ejection fraction phenotypes.Objective To identify the role of sUA across ejection fraction phenotypes in hospitalized elderly patients with chronic heart failure.Methods The medical records of elderly patients who were diagnosed with chronic heart failure were analyzed.All the patients received sUA testing within the first 24h following admission,and were divided into three groups according to the sUA level:low sUA group(sUA<304.2μmol/L,n=451),medium sUA group(sUA 304.2-387.2μmol/L,n=453),and high sUA group(sUA>387.2μmol/L,n=451).The endpoint was cardiovascular death,and Cox regression models were used to analyze the association between sUA level and risk of cardiovascular death.Results Totally 1355 patients were included and the median follow-up period was 18 months.A total of 92 cardiovascular deaths(6.8%)occurred in the whole cohort.There were 47(13.9%),24(6.1%),and 21(3.4%)cardiovascular deaths in heart failure with reduced ejection fraction(HFrEF),heart failure with mid-range ejection fraction(HFmrEF),and heart failure with preserved ejection fraction,respectively.Compared with the low sUA group,the high sUA group had higher risk of cardiovascular deaths(adjusted HR=2.141,95%CI:1.199-3.824,P=0.01).In the subgroup analysis,among patients with HFrEF,the risk of adverse events was higher in the high sUA group compared to the low sUA group(HR=4.151,95%CI:1.866-9.234,P<0.001).Among patients with HFmrEF,the risk of cardiovascular death events was also higher in the high sUA group compared to the low sUA group(HR=4.724,95%CI:1.664-13.414,P=0.004).Conclusion In hospitalized elderly patients with chronic heart failure,sUA is an independent predictor of adverse outcome,which can be observed in HFrEF and HFmrEF patients.