血清尿酸水平与冠心病患者远期预后的分析

Relationship between serum uric acid level and long-term prognosis in patients with coronary heart disease

  • 摘要: 目的 探讨血清尿酸水平与冠心病患者远期预后的关系。 方法 回顾性分析2011年1月- 2014年9月于解放军总医院住院的冠心病患者3 679例,年龄(61.46±11.66)岁,记录患者的入院血压、心率、体质量、身高及血液生化指标,对所有观察对象进行随访,平均随访(39.0±11.0)个月。终点事件定义为心血管病相关死亡。按尿酸值四分位数将病例分成四组,从低到高分别为Q1、Q2、Q3、Q4,分析随尿酸水平增加冠心病患者远期预后的情况。 结果 分析表明血清尿酸(HR=1.035,95% CI:1.018 ~ 1.052,P=0.038)、年龄 (HR=1.070,95% CI:1.055 ~ 1.085,P< 0.001)是冠心病患者因心血管病死亡的独立危险因素; 他汀类药物(HR=0.419,95% CI:0.272 ~ 0.644,P< 0.001)和高密度脂蛋白(HR=0.321,95% CI:0.182 ~0.565,P< 0.001)是冠心病患者因心血管病死亡的保护因素。Kaplan-Meier曲线分析,随尿酸水平增加,累积生存率显著降低,尿酸与冠心病患者心血管病死亡风险之间可能存在阈值效应,即尿酸水平超过阈值时死亡风险大幅升高(P< 0.05)。 结论 高尿酸是冠心病患者因心血管病死亡的独立危险因素,控制尿酸水平有望降低冠心病患者的死亡风险。

     

    Abstract: Objective To investigate the relationship between serum uric acid level and long-term prognosis in patients with coronary heart disease. Methods From January 2011 to September 2014, clinical data about 3 679 patients of coronary heart disease with an average age of (61.46±11.66) years in Chinese PLA General Hospital were retrospectively analyzed, and their blood pressure, heart rate, weight, height and blood biochemical tests results were recorded. The primary endpoint was defined as cardiovascular disease related death and the average follow-up period was (39.0±11.0) months. Patients were divided into four groups by uric acid levels, and then the relationship between serum uric acid level and long-term prognosis was analyzed. Results Multivariate cox-regression analysis showed that serum uric acid (HR=1.035; 95% CI: 1.018-1.052; P=0.038) and age (HR=1.070; 95% CI: 1.055-1.085; P< 0.001) were independent risk factors for cardiovascular disease related death in patients with coronary heart disease. While, statins(HR=0.419; 95% CI: 0.272-0.644; P< 0.001) and HDL-C(HR=0.321; 95% CI: 0.182-0.565; P< 0.001) were protective factors.Kaplan-Meier analysis showed that with the increase of serum uric acid level, the cumulative survival rate decreased significantly.There might be a threshold effect between uric acid and mortality in patients with coronary heart disease. Conclusion Uric acid is an independent risk factor for cardiovascular disease related death in patients with coronary heart disease. Thus, control of hyperuricemia is expected to reduce mortality in patients with coronary heart disease.Keywords: uric acid; coronary heart disease; mortality

     

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