血尿酸水平对老年冠心病心力衰竭患者预后的影响  

Influence of serum uric acid on prognosis of elderly patients with chronic heart failure and coronary artery disease

作　　者：宋芳[1] 王林[1] 

机构地区：[1]天津医科大学第二医院干部保健科,300211

出　　处：《中国心血管杂志》2013年第4期249-252,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的分析老年冠心病心力衰竭患者的血尿酸水平对其预后的影响。方法入选2005年1月至2007年12月老年冠心病合并慢性心力衰竭患者783例。按尿酸水平的四分位间距分为低水平组(195例)、较低水平组(195例)、较高水平组(195例)和高水平组(198例),比较各水平组的病死率。按随访期是否死亡分为死亡组(199例)和生存组(584例),采用多因素Cox回归分析尿酸水平对老年冠心病合并心力衰竭患者预后的影响。结果从低到高水平尿酸组的病死率依次为23.6%、21.0%、15.9%和43.4%,组间比较差异有统计学意义(χ2=44.66,P<0.01)。死亡组患者的年龄[(73.3±8.7)岁比(70.0±9.7)岁,t=-4.24,P=0.000]、尿酸水平[(423.71±189.84)μmol/L比(353.28±122.58)μmol/L,t=-6.014,P=0.000]及合并贫血(24.1%比17.6%,χ2=4.008,P=0.045)、心房颤动(31.2%比17.5%,χ2=16.800,P=0.000)、肾衰竭(34.7%比22.1%,χ2=12.441,P=0.000)的比例均大于生存组,而射血分数(49.43%±12.19%比56.49%±11.14%,t=5.33,P=0.000)、服用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂的比例(70.9%比78.9%,χ2=5.458,P=0.019)小于生存组。高水平的尿酸(≥437.0μmol/L,HR=1.520,P=0.044)、年龄(HR=1.026,P=0.002)、纽约心脏病协会(NYHA)心功能分级Ⅲ～Ⅳ级(HR=1.300,P=0.006)及心房颤动(HR=1.547,P=0.006)是老年冠心病心力衰竭患者预后不良的独立危险因素。结论血尿酸水平可作为老年冠心病心力衰竭患者心原性死亡的预后指标,其作用独立于影响心力衰竭患者生存的其他因素,具有一定的临床预后判断价值。Objective To study the influence of serum uric acid （UA） on prognosis of elderly patients with chronic heart failure （CHF） and coronary artery disease （CAD）. Methods From January 2005 to December 2007, 783 patients clinically diagnosed with CHF and CAD were enrolled from the cardiology department of 2nd Hospital Tianjin Medical University. Patients were divided into four groups according to serum UA level （quartile）. During the mean follow up of 35 months, 199 cases died and 584 survived. Cox regression analysis was used to confirm the associations of uric acid level and prognosis of the patients. Results Mortality was significantly different （P 〈0. 01 ） among the groups. Compared with survived patients, those died were older [ （73.3 ± 8.7 ） years vs. （70. 0 ± 9. 7 ） years, t = - 4. 24, P = 0. 000], had higher serum UA level [ （423.71 _± 189.84） μmol/L vs. （353.28 ± 122. 58） μmol/L, t =- 6. 014, P = 0. 000 ] and had more proportion of anemia （24. 1% vs. 17.6%, X2 = 4. 008, P = 0. 045 ）, atrial fibrillation （31.2% vs. 17. 5% , X^2 = 16. 800, P =0. 000） and renal failure （34. 7% vs. 22. 1%, X^2 = 12. 441, P =0. 000）, while had lower ejection factor （49.43% ± 12. 19% vs. 56.49% ± 11.14% , t =5.33, P = 0. 000）, less using of angiotensin converting enzyme inhibitors （70. 9% vs. 78.9%, X^2= 5.458, P=0. 019 ）. Multivariate Cox regression analysis showed that highest serum UA level （ ≥ 437 μmol/L, HR=1.520, P=0.044）, age （HR=1.026, P=0.002）, NYHA Ⅲ -Ⅳ（HR=1.300, P= 0. 006） and atrial fibrillation （ HR = 1. 547, P = 0. 006 ） were independent predictors of cardiac death. Conclusions Serum UA level is an independent predictor of cardiac death in elderly patients with CHF and CAD.

关 键 词：尿酸 心力衰竭 预后 

分 类 号：R541.4[医药卫生—心血管疾病] R541.6[医药卫生—内科学]