血尿酸水平与急性心肌梗死患者远期预后的关系研究  

Serum Uric Acid and Long-term Prognosis in Patients with Acute Myocardial Infarction

作　　者：陈强 陈应忠[2] 崔彩艳 蒋兴林 朱峰 李思艺 张玉玫 叶滔 蔡琳 CHEN Qiang;CHEN Yingzhong;CUI Caiyan;JIANG Xinglin;ZHU Feng;LI Siyi;ZHANG Yumei;YE Tao;CAI Lin(College of Clinical Medicine,Southwest Medical University,Luzhou 646000,China;Cardiovascular Department,the Third People's Hospital of Chengdu,Chengdu 610031,China)

机构地区：[1]西南医科大学临床医学院,四川泸州646000 [2]成都市第三人民医院心内科,四川成都610031

出　　处：《中国全科医学》2022年第5期561-567,共7页Chinese General Practice

基　　金：四川省科技计划应用基础研究项目(2021YJ0215)。

摘　　要：背景血尿酸(UA)是冠心病发生发展的重要危险因素,与急性心肌梗死(AMI)的预后显著相关,但这一结论仍存在一定争议,且国内缺少关于UA水平与AMI远期预后关系的大规模、多中心研究。目的探讨UA水平与AMI患者远期预后的关系。方法连续纳入2016年9月至2019年7月于成都市9家医院(成都市第一人民医院、成都市第二人民医院、成都市第三人民医院、成都医学院第一附属医院、都江堰市医疗中心、成都市郫都区人民医院、成都市双流区第一人民医院、金堂县第一人民医院、彭州市人民医院)就诊的1098例AMI患者,由经过培训的专业人员通过各医院电子病历系统收集相关基线资料,包括:(1)人口学资料:年龄、性别、吸烟情况;(2)临床合并症及相关资料:高血压、糖尿病、血压、心率、Killip分级、AMI类型[急性非ST段抬高型心肌梗死(NSTEMI)/急性ST段抬高型心肌梗死(STEMI)]、是否接受经皮冠状动脉介入治疗(PCI);(3)实验室检查:血肌酐(Scr)、UA、三酰甘油(TG)、总胆固醇(CHO)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、估算肾小球滤过率(eGFR);(4)出院后用药情况:阿司匹林、氯吡格雷/替格瑞洛、他汀类、β-受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)、利尿剂。通过门诊或电话询问并记录出院后随访期间主要心脑血管不良事件(MACCE)发生情况并以此为随访终点事件。依据随访期间是否发生MACCE将患者分为MACCE组、无MACCE组,比较两组患者基线资料。再根据《中国高尿酸血症与痛风诊疗指南(2019)》将患者分为A组:UA<420μmol/L,B组:420≤UA<480μmol/L,C组:UA≥480μmol/L,观察不同UA水平患者的预后差异。结果中位随访时间14.5(9.2,20.7)个月。1098例AMI患者中发生MACCE 173例(MACCE组),高尿酸血症366例。MACCE组患者年龄大于无MACCE组,Scr、UA、心率、女性比例、合并Background It is still controversial whether or not serum uric acid,a key risk for coronary heart disease,is significantly associated with prognosis of acute myocardial infarction(AMI).And there are rare large-scale and multicenter studies on serum uric acid and long prognosis of AMI in China.Objective To investigate the relationship between serum uric acid and long-term prognosis in AMI patients.Methods One thousand and ninety-eight AMI patients from 9 hospitals(Chengdu First People's Hospital,Chengdu Second People's Hospital,the Third People's Hospital of Chengdu,the First Affiliated Hospital of Chengdu Medical College,Dujiangyan Medical Center,Pidu District People's Hospital,Chengdu,Shuangliu District First People's Hospital,Jintang First People's Hospital,the People's Hospital of Pengzhou)in Chengdu during September 2016 to July 2019 were consecutively reSScruited.Baseline data were collected via the electronic medical record system of each hospital by trained professionals,including:(1)demographic data:age,gender,prevalence of smoking;(2)clinical complications and related information:hypertension,diabetes,blood pressure,heart rate,Killip class,AMI type(NSTEMI or STEMI),prevalence of percutaneous coronary intervention(PCI);(3)laboratory parameters:serum SScreatinine(Scr),uric acid(UA),triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),estimated glomerular filtration rate(eGFR);(4)post-discharge medication:aspirin,clopidogrel/tigrelol,statins,Beta-blockers,ACEI/ARB,diuretics.Baseline data were compared between patients with and without major adverse cardiovascular and cerebrovascular events(MACCE)during post-discharge follow-up.Then,prognosis was compared aSScross UA tertile subgroups〔A:UA<420μmol/L;B:420≤UA<480μmol/L;C:UA≥480μmol/L〕stratified by the diagnostic SScriteria for hyperuricemia in Guideline for the Diagnosis and Management of Hyperuricemia and Gout in China(2019).Results The median follow-up time for all participa

关 键 词：心肌梗死 心血管疾病 冠心病 尿酸 预后 预测 生存分析 灵敏度 特异度 

分 类 号：R542.22[医药卫生—心血管疾病]