治疗前血清尿酸对高血压性急性心力衰竭患者预后的预测价值

Prognostic value of serum uric acid levels in patients with acute heart failure with hypertension

目的 探讨高血压性急性心力衰竭患者治疗前的血清尿酸(SUA)水平与治疗后疾病严重程度及5年病死率的相关性。方法 选取了河北省沧州市黄骅市人民医院2019年9月—2022年9月收治的122例高血压性急性心力衰竭患者,根据入院时的SUA水平将其分为高尿酸血症组(男性SUA≥420μmol/L,女性SUA≥360μmol/L)和正常尿酸组,比较两组患者的基线特征、临床表现和5年随访结果。采用多变量Cox回归模型评估SUA水平对5年病死率的影响,并使用Kaplan-Meier生存曲线进行生存分析。比较两组左心室功能和心血管不良事件(MACE)。结果 高尿酸血症组患者的BMI、白细胞、白蛋白、肌酐、尿素氮、胆固醇、低密度脂蛋白胆固醇SUA水平显著高于正常尿酸组,血小板和肾小球滤过率显著低于正常尿酸组(P<0.05)。在冠状动脉狭窄情况,高尿酸血症组涉及的血管支数和Gensini积分均显著高于正常尿酸组(P<0.05),且血清尿酸水平与Gensini积分呈强正相关(r=0.778,P<0.05)。随访结果显示,高尿酸血症组的5年病死率显著升高,且尿酸是5年病死率的独立危险因素(HR=1.017,95%CI=1.011~1.024,P<0.001)。出院前的心脏超声检查结果显示,两组间的LVESV和LVEDV比较差异有统计学意义(P<0.05),但LVEF组间差异无统计学意义(P>0.05)。此外,尽管高尿酸血症组的MACE发生率偏高,但两组间差异并无统计学意义(P>0.05)。结论 在高血压性急性心力衰竭患者群体中,治疗前SUA水平与疾病严重程度以及5年病死率增加相关。治疗前高水平SUA可预测高血压性急性心力衰竭患者的不良结局。

Objective The aim of this study was to investigate the correlation between pre-treatment serum uric acid(SUA) levels in patients with hypertensive acute heart failure and post-treatment disease severity and 5-year mortality.Methods One hundred and twenty-two patients with hypertensive acute heart failure were selected and divided into a hyperuricemia group(SUA ≥420 μmol/L in men and SUA ≥360 μmol/L in women) and a normaturic group according to their SUA levels on admission,and the baseline characteristics,clinical manifestations,and 5-year follow-up results were compared between the two groups.Multivariate Cox regression models were used to assess the effect of SUA levels on 5-year mortality,and survival analyses were performed using Kaplan-Meier survival curves.Results The levels of BMI,white blood cell,albumin,liver anhydride,urea nitrogen,cholesterol,low density lipoprotein cholesterol and SUA in hyperuricemia group were significantly higher than those in hyperuricemia group(P<0.05).In terms of coronary artery stenosis,the number of vessel branches involved and Gensini score were significantly higher in the hyperuricaemia group than in the normal group(P<0.05),and the serum uric acid level showed a strong positive correlation with the Gensini score(r=0.778,P<0.05).Follow-up results showed that the 5-year mortality rate was significantly higher in the hyperuricaemia group and that uric acid was an independent risk factor for 5-year mortality(HR=1.017,95%CI=1.011-1.024,P<0.001).Pre-discharge cardiac ultrasound showed a statistically significant difference in LVESV and LVEDV between the two groups(P< 0.05),but not in LVEF(P>0.05).In addition,although the incidence of MACE was high in the hyperuricaemia group,the difference between the two groups was not statistically significant(P>0.05).Conclusion Pre-treatment SUA levels were associated with increased disease severity as well as 5-year mortality in a population of patients with hypertensive acute heart failure.High pretreatment levels of SUA increased adverse outcomes in patients with hypertensive acute heart failure,a finding that suggests the importance of SUA levels in disease management and prognostic assessment.