高尿酸血症与高龄老年非瓣膜性心房颤动患者长期预后的相关性分析

Association between hyperuricemia and long-term prognosis in elderly patients with nonvalvular atrial fibrillation

目的探讨高尿酸血症与80岁及以上(高龄)老年非瓣膜性心房颤动(房颤)患者预后的关系。方法回顾性研究。纳入2018—2022年就诊于西安交通大学第二附属医院的高龄老年非瓣膜性房颤患者268例,收集患者临床资料。根据血尿酸水平(是否≥420μmol/L)分为高尿酸血症组(94例)和血尿酸正常组(174例),比较两组临床特点,并分析高尿酸血症与高龄老年非瓣膜性房颤患者预后的关系。结果与血尿酸正常组比较,高尿酸血症组合并冠心病、纽约心脏病协会(NYHA)心功能分级Ⅱ级和持续性房颤比例更高,CHA 2DS 2-VASc和HAS-BLED评分更高,N末端B型利钠肽原、血肌酐水平更高,估算的肾小球滤过率、高密度脂蛋白胆固醇水平更低,左心房前后径更大,左心室射血分数更低,差异均有统计学意义(均为P<0.05)。中位随访22(11,36)个月,共失访27例(10.1%),62例(23.1%)患者发生复合终点事件,其中高尿酸血症组30例(31.9%),血尿酸正常组32例(18.4%)。Kaplan-Meier生存曲线显示,高尿酸血症组复合终点事件发生率显著高于血尿酸正常组(log-rank P=0.001)。单因素Cox回归分析显示,高尿酸血症、血尿酸水平、NYHA心功能分级Ⅱ级、左心室舒张末期前后径和抗凝治疗是复合终点事件发生的影响因素(均为P<0.05)。将高尿酸血症与其他多项混杂因素纳入多因素Cox回归分析后显示,高尿酸血症仍是高龄老年非瓣膜性房颤患者远期预后不良的独立预测因素(HR=1.849,95%CI:1.049~3.259,P=0.033)。结论合并高尿酸血症的高龄老年非瓣膜性房颤患者远期预后较差,高尿酸血症是高龄老年非瓣膜性房颤患者预后不良的独立危险因素。

Objective To analyze the association between hyperuricemia and prognosis in elderly patients(aged 80 and over)with nonvalvular atrial fibrillation.Methods This was a retrospective study.The clinical characteristics and follow up data of 268 elderly patients with nonvalvular atrial fibrillation between 2018 and 2022 were retrospectively collected.The clinical characteristics between patients with hyperuricemia(serum uric acid≥420μmol/L,94 cases)and normal uric acid(serum uric acid<420μmol/L,174 cases)were compared,and the relationship between hyperuricemia and their prognosis were further analyzed.Results Compared with patients with normal uric acid,those with hyperuricemia were more frequently with coronary artery disease,New York Heart Association(NYHA)classⅡ,and persistent atrial fibrillation.They also had higher level of CHA 2DS 2-VASc score,HAS-BLED score,N-terminal pro-brain natriuretic peptide(NT-proBNP),serum creatinine and left atrial diameters,and lower level of the estimated glomerular filtration rate(eGFR),high-density lipoprotein cholesterol(HDL-C)and left ventricular ejection fraction(LVEF)(all P<0.05).During a median follow up of 22(11,36)months,27 patients(10.1%)were lost follow up.30(31.9%)and 32(18.4%)composite endpoints occurred among patients with hyperuricemia and normal uric acid,respectively.Kaplan-Meier analysis showed that patients with hyperuricemia had a poorer prognosis during follow-up(log-rank P=0.001).In the univariate Cox analyses,hyperuricemia,the serum uric acid level,NYHA classⅡ,left ventricular end-diastolic diameter,and anticoagulant therapy were associated with composite endpoints(all P<0.05).After adjusting for multiple confounding factors,hyperuricemia was also independently associated with poor prognosis in elderly patients with atrial fibrillation(HR=1.849,95%CI:1.049-3.259,P=0.033).Conclusions Hyperuricemia is associated with poor prognosis in elderly patients with nonvalvular atrial fibrillation.