尿酸对溶栓治疗的急性缺血性脑卒中患者预后的影响  

Prognostic significance of uric acid in the patients with acute ischemic stroke treated with thrombolysis

作　　者：刘宣[1] 潘曙明[1] 王海嵘[1] 刘佳福[1] 陈向军[1] 

机构地区：[1]上海交通大学医学院附属新华医院急救中心,上海200092

出　　处：《中国急救医学》2013年第5期420-423,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨溶栓治疗的急性缺血性脑卒中患者入院时血清尿酸水平与短期预后的关系。方法连续收录了84例溶栓治疗的急性缺血性脑卒中患者。记录其人口统计学特征，病情严重程度以及入院时血清尿酸水平。患者在随访90d时若出现死亡或残疾（改良Rankin评分，mRSI〉2）则定义为预后不良。采用Logistic逐步回归模型对可能影响预后的因素进行分析。结果预后良好的患者（mRS为0～1）血清尿酸水平要显著高于预后不良的患者（mRS为2～6）。用逐步向前法进行多元Logistic回归分析发现，尿酸是影响患者短期预后的独立保护因素。ROC曲线提示，尿酸用来预测患者预后的准确性并不高，曲线下面积仅为0．680±0．058。Pearson相关性分析发现，尿酸与mRS评分呈负相关。结论溶栓治疗的脑卒中患者的良好预后和血清尿酸水平升高有关，但仍需要有更大规模的临床试验进一步探索外源性的尿酸加上溶栓联合治疗脑卒中的安全性与有效性。Objective To evaluate the relationship of serum uric acid levels on admission with short -term clinical outcome in patients with acute ischemic stroke treated with thrombolysis. Methods A total of 84 consecutive patients treated with thrombolysis were included. Demographics, disease severity and serum uric acid levels on admission were prospectively collected. Adverse clinical outcome was defined as death or dependence （modified Rankin Scale, mRS ~ 2） at 90 d. Stepwise Logistic regression models were used to analyze potential factors affecting the outcome. Results Serum uric acid levels were significantly higher in the patients with excellent outcome （ mRS 0 to 1 ） than in patients with poor outcome （ mRS 2 to 6）. Forward stepwise multivariate Logistic regression analysis revealed that uric acid was an independently protective factor affecting short - term outcome. ROC analysis demonstrated uric acid had a low power for predicting outcome as suggested by the AUC of 0. 680 ~ 0. 058. Pearson correlation tests indicated there was an inverse correlation between uric acid and mRS score. Conclusion Increased serum uric acid levels are associated with better outcome in patients with stroke treated with reperfusion therapies. The clinical safety and efficacy of dual administration of exogenous uric acid and thrombolysis need further investigation in a larger clinical trial.

关 键 词：急性缺血性脑卒中 尿酸 溶栓 神经保护作用 改良Rankin评分 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]