高尿酸与冠状动脉严重程度及支架置入后的预后相关性

Relationship between hyperuricaemia and severity of coronary artery disease and long-term outcome of coronary artery disease patients after drug-eluting stent implantation

目的探讨高尿酸与冠心病患者冠状动脉病变严重程度及置入支架后预后的相关性。方法采取回顾性研究收集2013年10月至2014年12月在山西医科大学第二医院住院患者270例,经冠状动脉造影检查确诊冠心病,并置入第二代药物洗脱支架,进行随访1年。根据尿酸水平分为尿酸升高组(n=120例)和尿酸水平正常对照组(n=150例),搜集两组病例冠状动脉病变部位、程度及性质,采用Gensini积分评估冠状动脉严重程度。随访两组患者1年主要心脑血管不良事件(MACCE)发生情况,根据随访结果分析两组1年后MACCE差异性,并采用Cox多因素回归分析判断高尿酸与冠心病支架置入患者MACCE相关性。结果高尿酸组较对照组冠状动脉病变重,表现为长病变所占比例更大[63.33%(76/120)vs.44.00%(66/150),P=0.02],闭塞病变所占比例更大[28.33%(34/120)vs.15.33%(23/150),P=0.009],Gensini积分更高[(61.225±26.56)分vs.(47.467±25.03)分,P<0.001]。随访1年,高尿酸组MACCE累积发生率高于对照组[20.83%(25/120)vs.10.67%(16/150),P=0.02]。Cox比例风险模型分析得出,吸烟(OR=1.274,95%CI 1.057~2.860,P=0.04)、糖尿病(OR=1.190,95%CI 1.050~2.400,P=0.03)、年龄(OR=1.095,95%CI 1.096~2.027,P=0.03)、心功能(OR=1.086,95%CI 1.035~2.145,P=0.02)、高尿酸(OR=1.051,95%CI 1.026~1.986,P=0.01)及Gensini积分(OR=1.009,95%CI 1.001~1.986,P=0.05)分别是影响MACCE发生的独立预测因素。结论高尿酸与冠心病冠状动脉病变严重程度呈正相关,高尿酸是支架置入后1年内发生MACCE的独立预测因素。

Objective To explore the relationship between hyperuricaemia and severity of coronary artery lesions and the prognosis in coronary artery disease(CAD) patients after drug-eluting stent implantation. Methods A total of 270 consecutive CAD patients confirmed by coronary angiography(CAG) and implanted with DES in our department between October 2013 and December 2014 were enrolled in this prospective study. Patients were classified into hyperuricaemia and non-hyperuricaemia. Compared pathological characteristics of coronary and 1-year major adverse cardiac and cerebrovascular events(MACCE). Cox multiple factors regression analysis were established to analyze the relationship between high uric acid and the incidence of MACCE rate after a follow-up of 1-year. Results Compared with no-hyperuricaemia, the higher incidence of the long lesion(63.33% vs. 44.00%, P=0.02) and occlusive disease(28.33% vs. 15.33%, P=0.009), the higher score of Gensini were shown in hyperuricaemia(61.225±26.56 vs. 47.467±25.03, P<0.001). The 1-year incidence of MACCE was also higher in hyperuricaemia group compared with non-hyperuricaemia group(20.83% vs. 10.67%, P=0.02). Multivariate Cox hazards regressions analysis showed that smoking(OR=1.274, 95% CI 1.057-2.860, P=0.04), diabetes mellitus(OR=1.190, 95% CI 1.050-2.400, P=0.03), age(OR=1.095, 95% CI 1.096-2.027, P=0.03), heart function(OR=1.086, 95% CI 1.035-2.145, P=0.02) and hyperuricaemia(OR=1.051, 95% CI 1.026-1.986, P=0.01) were the independent predictor of 1-year MACCE. Conclusion Hyperuricaemia has positive correlation with severity of coronary artery stenosis, and serves as an independent predictor of MACCE after drug-eluting stent implantation in CAD patients.