血尿酸水平与肺高血压的相关性研究  

Serum uric acid is associated with disease severity and an important predictor for clinical outcome in patients with pulmonary hypertension

作　　者：罗冬玲[1] 张曹进[1] 黄奕高[1] 黄涛[1] 李贺智[1] 

机构地区：[1]广东省心血管病研究所广东省医学科学院广东省人民医院心内利,广州510000

出　　处：《中华心血管病杂志》2017年第6期496-500,共5页Chinese Journal of Cardiology

基　　金：广东省公益研究与能力建设项目（2014A020212732）

摘　　要：目的研究血尿酸水平对肺高血压严重程度及其预后的预测价值。方法选取2010年1月至2015年12月在广东省人民医院住院行左、右心导管确诊为肺高血压的患者[静息状态下右心导管监测的肺动脉平均压≥25mmHg（1mmHg=0．133kPa）]作为肺高血压组，共173例。另选取因其他疾病行左、右心导管并排除肺高血压的患者作为对照组，共51例。收集入选者的基线资料并进行随访，随访中位数时间为24个月（6-71个月），定义心力衰竭死亡、心脏移植为终点事件。检测所有入选者的血尿酸、N末端B型利钠肽原（NT-proBNP）、血肌酐、血红蛋白等实验室检查指标。将患者的血尿酸水平及其他实验室指标与右心导管结果进行相关性分析。比较对照组及不同严重程度的肺高血压患者的血尿酸水平。分析尿酸作为疾病严重程度预测因子的敏感度和特异度，并将该临界值作为随访分析的分组指标，分析两组预后的差异。结果（1）实验室指标与右心导管指标的相关性分析结果：肺高血压组患者血尿酸与肺血管阻力、体循环阻力和右心房平均压呈正相关（r分别为0．398、0．244和0．26，P均〈0．01），与心脏指数和混合静脉血氧饱和度呈负相关（r分别为-0．278和-0．322，P均〈0．01）。肺高血压组患者血尿酸水平高于对照组（P〈0．05），且重度肺高血压组高于轻中度肺高压组（P〈0．05）。经ROC曲线计算发现，当血尿酸高于425．5μmol／L时预测肺高血压患者预后敏感度和特异度较好（敏感度50％，特异度72％，ROC曲线下面积=0．617，95％C10．532～0．703）。（2）肺高压患者血尿酸水平与预后的关系：以425．5μmol／L为分界点，将肺高血压组患者分为高尿酸组（血尿酸〉425．5μmol／L，n=66）及低尿酸组（血尿酸≤425．5μmol／L，n=107）。结果发现，高尿酸组较低尿酸组患者预后差（P=Objective The growing body of literature showed a link between uric acid and pulmonary hypertension （PH） , but the impact of hyperuremia on outcome of patients with PH has not been well defined. Therefore, the present study was performed to analyze the impact of uric acid on outcome of PH patients. Methods One hundred seventy-three PH patients （ 112 females, mean age 38 years old） , who were hospitalized in our department between January 2010 and December 2015, were included in our study, the PH diagnosis was made based on right heart catheterization examination result （mean pulmonary artery pressure≥25 mmHg（ 1 mmHg =0. 133 kPa））. PH patients were divided into mild to moderate PH group （Rp/Rs ≤0.6, n = 97 ） and severe PH group （ Rp/Rs 〉 0. 6, n = 76）. Fifty-one patients （ 33 females, mean age 45 years old） without PH based on right heart catheterization were included as control subjects. All participants were followed up for a median of 24 months （6 -71 months）. Clinical endpoints were defined as cardiogenie death or heart-and-lung transplantation. Results Uric acid was positively correlated with pulmonary vascular resistance （ r = 0. 398, P 〈 0. 01 ）, systemic vascular resistance （ r = 0. 244, P 〈 0. 01 ） and mean right atrial pressure （r = 0. 26, P 〈 0.01 ）, and was negatively correlated with cardiac index（ r = - 0. 278, P 〈 0.01 ） and mixed venous oxygen saturation （ r = - 0. 322 ,P 〈 0. 01 ） in PH patients. Serum uric acid level was significantly higher in patients with severe PH than in patients with mild-to-moderate PH and the control subjects （ both P 〈 0. 05 ）. According to the receiver operating characteristic curve （ ROC）, 425.5 μmol/L was found to be the best cut-off value of serum uric acid level to predict the outcome of PH patients （ sensitivity 50%, specificity 72% ）. During follow-up, patients with higher level of uric acid （ 〉 425.5 μmol/L） were linked with poorer clinical outcome compared to patients with

关 键 词：高血压 肺性 尿酸 预后 

分 类 号：R544.1[医药卫生—心血管疾病]