中青年冠心病患者中血清尿酸水平与冠状动脉狭窄程度的关系:一项单中心回顾性研究  

Relationship Between Serum Uric Acid Level and Coronary Artery Stenosis in Young and Middle-Aged Patients with Coronary Heart Disease:A Single-Center Retrospective Study

作　　者：李子文 蔺雅娟 樊瑞 夏云龙[1] 杨晓蕾[1] LI Ziwen;LIN Yajuan;FAN Rui;XIA Yunlong;YANG Xiaolei(Department of Cardiology,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,Liaoning,China)

机构地区：[1]大连医科大学附属第一医院心内科,辽宁大连116011

出　　处：《心血管病学进展》2021年第12期1136-1141,1153,共7页Advances in Cardiovascular Diseases

基　　金：国家自然科学基金(81900439/81970286)。

摘　　要：目的通过回顾性研究分析中青年冠心病患者中影响冠状动脉血管狭窄程度的临床因素,探讨中青年冠心病患者入院时血清尿酸(SUA)水平与冠状动脉血管狭窄程度之间的流行病学关系。方法连续入选2010年1月—2020年6月于大连医科大学附属第一医院就诊的中青年冠心病患者,年龄20~65岁,共计8644例,排除无SUA值、高血压、糖尿病、痛风、肿瘤、肾功能不全、心力衰竭等影响SUA水平的患者,最终纳入中青年冠心病患者共3957例。根据冠状动脉造影结果分为重度狭窄组(任何一支冠状动脉狭窄程度≥75%)(n=1016)和轻中度狭窄组(n=2941)。比较两组患者的临床特点及冠状动脉造影结果,分析SUA水平是否对冠状动脉血管狭窄程度产生影响。结果(1)基线资料显示冠状动脉血管重度狭窄组患者的SUA水平为360(307~423)μmol/L,显著高于轻中度狭窄组335(279~399)μmol/L(P<0.001);且Spearman相关分析显示,SUA水平与冠状动脉血管狭窄程度之间呈正相关(r=0.129,P<0.001);应用二元logistic回归分析,以SUA Q1分层为参考,随着SUA水平的升高,冠状动脉血管重度狭窄的风险升高,Q3、Q4的校正OR值分别为1.267与1.372倍。(2)ROC曲线示20~35岁冠心病人群中,SUA对重度冠状动脉血管狭窄具有较高的预测价值(AUC=0.741,灵敏度75.5%,特异度65.5%)。且SUA>422.5μmol/L比SUA≤422.5μmol/L患者重度狭窄的患病率高(44.2%vs 11.9%,P<0.001)。(3)对20~35岁人群进行多因素二元logistic回归分析显示,SUA>422.5μmol/L的患者冠状动脉血管重度狭窄的风险是SUA≤422.5μmol/L者的5.8倍(OR=5.8,95%CI 2.020~16.653,P=0.001)。结论SUA水平与中青年冠心病患者冠状动脉狭窄程度呈显著相关性,患者SUA水平越高,冠状动脉血管重度狭窄的风险越大;在20~35岁冠心病人群中,SUA可能对冠心病患者冠状动脉狭窄程度具有较高的预测价值。Objective Through a large sample retrospective study,to examine the clinical factors influencing the extent of coronary vascular stenosis in young and middle-aged patients with coronary heart disease,and to investigate the effect of serum uric acid(SUA)level on the extent of coronary vascular stenosis.Methods A total of 8644 young and middle-aged patients with coronary heart disease,aged 20~65 years,were admitted at The First Affiliated Hospital of Dalian Medical University from January 2010 to June 2020.After excluding patients without SUA value,and patients with hypertension,diabetes,gout,tumor,renal function deficiency,and heart failure,finally 3957 young and middle-aged patients were included.According to coronary angiography,they were divided into severe stenosis group(n=1016)and mild-to-moderate stenosis group(n=2941).The clinical characteristics and the results of coronary angiography were compared between the two groups,and whether the SUA level had an effect on the extent of coronary artery stenosis was analyzed.Results(1)The baseline data shows that the SUA level of patients with severe coronary artery stenosis group was 360(307~423)μmol/L,which is significantly higher than that of the mild-to-moderate stenosis group 335(279~399)μmol/L(P<0.001);and Spearman correlation analysis shows that there is a positive correlation between SUA level and coronary artery stenosis(r=0.129,P<0.001);binary logistic regression analysis shows,compared with the first quartile of SUA,as the level of SUA increasing,the risk of severe coronary artery stenosis is increased,and the adjusted OR values of Q3,and Q4 were 1.267 and 1.372,respectively.(2)ROC curve shows that in patients with coronary heart disease aged 20~35 years,SUA has a high predictive value for severe coronary artery stenosis(AUC=0.741,sensitivity 75.5%,specificity 65.5%),and the prevalence of severe stenosis is higher in patients with SUA>422.5μmol/L than that with SUA≤422.5μmol/L(44.2%vs 11.9%,P<0.001).(3)Multivariate logistic regression analysis of 20~

关 键 词：尿酸 冠心病 年龄 

分 类 号：R54[医药卫生—心血管疾病]