血清尿酸水平对脑卒中患者预后影响的探讨  

The influence of serum uric acid levels on the prognosis of patients with stroke

作　　者：李永姝[1] 李旭[2] 王晶[1] 渠会彬 贾克刚[1] 

机构地区：[1]天津医科大学心血管病临床学院,泰达国际心血管病医院检验科,天津市300457 [2]天津市环湖医院检验科,天津市300060 [3]河北北方学院检验系,张家口市075000

出　　处：《实用检验医师杂志》2013年第3期137-141,共5页Chinese Journal of Clinical Pathologist

基　　金：滨海新区医药卫生科技重点项目(2011BHKZ003)

摘　　要：目的探讨血清尿酸(uric acid,UA)水平对脑卒中患者预后评估的临床价值。方法以1332例脑卒中患者为研究对象,按照疾病的类型和UA水平分为出血性脑卒中低UA组(A组)124例,出血性高UA组(B组)28例,梗死性低UA组(C组)1039例和梗死性高UA组(D组)141例。收集所有患者的血压、年龄、血清UA、血脂、血糖、WBC、血红蛋白、纤维蛋白原水平和住院天数等临床基本资料,并进行统计学分析。采用COX回归风险模型对患者预后进行生存分析,组间生存曲线的比较使用Ka—plan—Meier法,并用对数秩和分析进行组间比较。结果临床资料分析中,A组和B组患者的年龄、痛风、蛋白尿、肌酐、UA、胆固醇、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL—C)经比较差异均有统计学意义(P均<0.05);C组和D组患者的舒张压、糖尿病、痛风、卒中史、蛋白尿、肌酐、UA、胆固醇、甘油三酯、LDL—C和WBC经比较差异亦均有统计学意义(P均<0.05)。COX回归分析中,高尿酸血症与发生终点事件的相对危险度为1.004(P=0.000)。梗死性脑卒中患者中,低UA发生终点事件的概率为20.3%,高UA为34.0%,两组差异有统计学意义(P<0.05)。结论血清UA水平与出血性脑卒中患者的预后无明显关系,而与梗死性脑卒中患者的预后密切相关。血清UA可作为梗死性脑卒中患者再发卒中的独立危险因素。Objective To study the clinical value effect of serum uric acid （UA） level on the prognosis evaluation of the stroke patients. Methods 1332 cases of hospitalized patients with stroke were the research object. According to the type of disease and UA level, they were divided into 124 cases low UA with hemorrhage（A group）, 28 cases high UA with hemorrhage（B group）, 1039 cases low UA with infarction（C group）, and 141 cases high UA with infarction （D group）. All patients＇ basic clinical data including blood pressure, age, UA, blood fat, glucose, WBC, hemoglobin, fibrinogen were detected, and the data were analyzed by statistical analyze. COX proportional hazards model was used to make the survival analysis of discharged pa- tients. Kaplan-Meier survival analysis was used to compare survival curves among the different groups and Log Rank Statistic was used to compare among the different groups. Results In clinical data analyze, the differ- ences of age, gout, proteinuria, creatinine, UA, cholesterol and low density lipoprotein cholesterol （LDL-C） between A group and B group all had statistical significance （Pall〈 0.05 ）. And the differences of diastolic blood pressure, diabetes mellitus, gout, stroke history, proteinuria, creatinine, UA, cholesterol, triglyceride, LDL-C and WBC between C and D group all had statistical significance （Pall〈 0.05）. In COX regression anal- ysis, the relative risk between hyperuricemia and outcome event was 1.004 （P= 0.000）. For the patients with cerebral infarction, the outcome event probability of low UA group was 20.3%, high UA group was 34.0%, and the difference had statistical significance （P〈 0.05）. Conclusion For the relationship of serum UA level and the prognosis effect on cerebral hemorrhage patients, we do not find obvious statistical significance, but for cerebral infarction in patients, there is significance relationship between them.

关 键 词：血清尿酸 梗死性脑卒中 缺血性脑卒中 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]