血尿酸水平与特发性肺动脉高压病情和预后的关系  

Relationship between serum uric acid levels and patient conditions and prognosis in idiopathic pulmonary arterial hypertension

作　　者：李震南[1] 何建国[1] 柳志红[1] 顾晴[1] 倪新海[1] 程显声[1] 熊长明 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心血管疾病国家重点实验室,100037

出　　处：《中华医学杂志》2012年第46期3261-3264,共4页National Medical Journal of China

基　　金：“十一五”国家科技支撑计划项目（2006BA101A07）;首都医学发展科研基金（2009-1003）;北京市科技计划资助（Z090507017709032）

摘　　要：目的探讨血尿酸水平与特发性肺动脉高压（PAH）病情和预后的关系。方法连续人选经右心导管确诊为特发性PAH的患者。记录基线数据，并对其进行随访，随访终点为全因死亡。总结分析基线资料及随访结果，对基线资料进行相关性分析，对随访结果进行生存分析。结果2007年5月至2010年11月阜外心血管病医院入选76例特发性PAH患者，男27例，女49例，平均年龄（29．7±9．7）岁。其中，PAH功能分级Ⅱ级患者28例，Ⅲ级45例，Ⅳ级3例。患者基线肺动脉平均压为（65±16）mmHg，肺血管阻力（1677±669）dyn·s-1·cm-5，肺毛细血管楔压（9．6±5．0）mmHg，右心房平均压（9．8±6．1）mmHg，心指数（2．07±0．57）L·min-1·m-2，尿酸为（391±103）μzmo]／L。相关性分析发现，尿酸与患者的右心室舒张末期前后径呈正相关（r=0．28，P=0．018），与心指数呈负相关（r=-0．34，P=0．003）。分组比较发现，WHO-肺动脉高压分级Ⅱ级患者的平均血尿酸水平为362μmol／L，nI／iv级患者为412μmol／L，两组比较差异有统计学意义。高尿酸组（尿酸〉416．5μmol／L）的患者PAH功能分级、N末端B型利钠肽原、内皮素1水平偏高，心脏指数偏低，病情较重预后较差。生存分析发现，血尿酸水平正常的患者预后明显好于高尿酸的患者，差异有统计学意义。结论血尿酸水平与PAH患者的病情严重程度和预后呈明显相关。高水平的尿酸提示病情较重，预后较差。Objective To explore the relationship between serum uric acid levels and patient conditions and prognosis in idiopathic pulmonary arterial hypertension （IPAH）. Methods A total of 76 IPAH patients confirmed by fight heart catheterization were enrolled consecutively and followed up until the endpoint of all-cause death. Their baseline data were recorded and analyzed by Speaiman＇s rank test and independent t-test. And the follow-up outcomes were analyzed with Kaplan-Meier plots. Results There were 27 males and 49 females with a mean age of 29. 7±9. 7 years. They were classified into World Health Organization functional class （WHO-FC） Ⅱ（ n = 28 ）, class Ⅲ （ n = 45 ） and class IV （ n = 3 ）. Their baseline mean pulmonary artery pressure was （65 ＋ 16） mm Hg, pulmonary vascular resistance （ 1677±669） dyn · s-1· cm-5, pulmonary capillary wedge pressure （9.6 μ 5.0 ） mm Hg, mean right atrial pressure （9. 8 ±6. 1 ） mm Hg, cardiac index （2. 07 μ0. 57） L · min-1 · m-2 and serum uric acid （391 ±103） μmol/L. The correlation analysis indicated that the serum level of uric acid correlated positively with right ventricular diameter （ r = 0. 28, P = 0. 018 ） and negatively with CI （ r = - 0. 34, P = 0. 003 ）. Independent t-test results indicated that the patients with a higher level of uric acid were apt to have a worse WHO-FC, and the higher level uric acid group （serum uric acid 〉416. 5μmol/L） had a relative higher level of WHO-FC, NT-proBNP and endothelin-1. A lower level of CI denoted more severe conditions and prognosis. Survival analysis indicated that the serum level of uric acid could strongly predict survival in IPAH patients with over time and those with a high level of uric acid had a worse prognosis. Conclusion The serum level of uric acid correlates significantly with patient conditions and prognosis in IPAH. And a higher serum level of uric acid predicts worse conditions and prognosis.

关 键 词：尿酸 高血压 肺性 预后 

分 类 号：R543.2[医药卫生—心血管疾病]