高尿酸血症预测急性心力衰竭患者长期预后的临床价值

The long-term predictive value of hyperuricemia in acute heart failure

目的:探讨高尿酸血症与急性心力衰竭(心衰)患者长期预后的相关性。方法:前瞻性分析2012-2016年我院纳入并随访的急性心衰患者406例。根据入院患者尿酸水平分为高尿酸组(男性≥420μmol/L,女性≥360μmol/L)和尿酸正常组。随访24个月后比较2组全因病死率。绘制Kaplan-Meier曲线,并对可能影响全因死亡的因素进行多因素COX回归分析,探索高尿酸血症与心衰长期预后的相关性。结果:286例(70.4%)患者患有高尿酸血症。高尿酸血症通常合并有肾功能不全、N末端脑钠肽前体(NT-proBNP)水平更高、心功能更差的特点。随访24个月后,128例(31.5%)患者死亡,高尿酸血症与全因死亡增加相关(P=0.006)。多变量调整后,高尿酸血症为急性心衰患者全因死亡的独立预测因素(HR=1.64,95%CI:1.07~2.53,P=0.025)。结论:高尿酸血症为急性心衰患者长期全因死亡的独立预测因素。

Objective:To investigate the role of hyperuricemia in the long-term prognosis of acute heart failure.Method:Data from the observational,prospective,long-term heart failure registry were analyzed from 2012 to 2016 in our hospital.Patients with acute heart failure were divided into the hyperuricemia group(male≥420μmol/L,female≥360μmol/L)and the normal uric acid group according to the uric acid level in admission.Mortality was compared between the two groups after 24 months of follow-up.Kaplan-meier analysis and multivariate COX regression analysis were performed to explore the correlation between hyperuricemia and prognosis of acute heart failure.Result:Hyperuricemia occurred in 286 patients(70.4%).Hyperuricemia was associated with poorer kidney function,poorer NYHA classification,and higher NT-proBNP.After 24 months of follow-up,128 patients(31.5%)died,and hyperuricemia was associated with increased mortality(P=0.006).Adjusted with other variables,multivariate analysis showed hyperuricemia was an independent predictor of all-cause mortality in patients with acute heart failure(HR=1.64,95%CI 1.07-2.53,P=0.025).Conclusion:Hyperuricemia is an independent predictor of mortality in patients with acute heart failure.