不同血清尿酸水平对心力衰竭患者的预后价值  

The prognostic value of different serum uric acid levels in heart failure patients

作　　者：齐晨 关敬元 王锦溪[1] 周萍[1] 翟玫[1] 周琼[1] 张健[1] Qi Chen;Guan Jingyuan;Wang Jinxi;Zhou Ping;Zhai Mei;Zhou Qiong;Zhang Jian(Heart Failure Care Unit,Heart Failure Center,National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]北京协和医学院、中国医学科学院、阜外医院、国家心血管病中心、心力衰竭中心、心衰重症监护病区,北京100037

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2024年第1期2-9,共8页Chinese Journal of Heart Failure and Cardiomyopathy

摘　　要：目的探究心力衰竭(心衰)患者基线血清尿酸水平与预后的相关性。方法本研究入选了2006年11月至2016年11月在阜外医院心衰重症监护病区住院的1594例心力衰竭患者,对其进行长期、规律随访,主要终点事件是全因死亡。采用限制性立方样条函数拟合血清尿酸水平与终点事件发生风险的趋势。采用Kaplan-Meier曲线评估不同血清尿酸水平终点事件发生率差异。采用Cox风险回归模型分析不同血清尿酸水平对患者终点事件的预测价值。结果本研究中患者中位年龄为57.0岁,28.1%为女性。中位随访时间为975天,有640例患者发生了全因死亡,其中461例(72.4%)为心血管死亡,204例患者发生了心力衰竭再住院。Kaplan-Meier生存曲线显示,与血清尿酸第一三分位组(<6.3 mg/dL)患者相比,尿酸较高的第三三分位组(>8.5 mg/dL)患者全因死亡、心血管死亡及心血管死亡和心力衰竭住院的复合事件的发生率均更高(P<0.001),但随着随访时间延长,第一三分位组相比第二三分位组(6.3~8.5 mg/dL)显示出全因死亡终点事件增加的趋势。Cox风险回归模型校正患者临床特征、心力衰竭病因及合并症、实验室检查指标及用药后,单位血清尿酸水平升高与全因死亡[风险比(HR)1.07,95%可信区间(CI)1.03~1.11,P<0.001]、心血管死亡(HR 1.07,95%CI 1.02~1.12,P=0.005)、心血管死亡与心力衰竭住院的复合终点(HR 1.07,95%CI 1.03~1.11,P<0.001)风险增加均相关。与尿酸第一三分位组比,第三三分位组者全因死亡(HR 1.38,95%CI 1.09~1.75,P=0.008)、心血管死亡(HR 1.47,95%CI 1.11~1.96,P=0.008)、心血管死亡与心力衰竭住院的复合终点(HR 1.44,95%CI 1.14~1.92,P=0.003)风险均更高。结论血清尿酸水平升高是心力衰竭患者全因死亡、心血管死亡及心血管死亡与心力衰竭住院的复合终点的独立危险因素。Objective To investigate the correlation between baseline serum uric acid levels and prognosis in heart failure patients.Methods This study included 1594 patients with heart failure who were admitted to the Heart Failure Care Unit of Fuwai Hospital from November 2006 to November 2016.They underwent long-term,regular follow-up,with all-cause mortality as the primary endpoint.Restricted cubic spline functions were utilized to fit the trend of serum uric acid levels with the occurrence risk of endpoint events.Kaplan-Meier curves were employed to assess differences in endpoint event rates among patients with different serum uric acid levels.Cox proportional hazards regression models were used to analyze the predictive value of different serum uric acid levels for endpoint events in patients.Results In this study,the median age of the patients was 57.0 years,with 28.1%being female.The median follow-up duration was 975 days,during which 640 patients experienced all-cause mortality,among whom 461(72.4%)died from cardiovascular causes,and 204 patients were readmitted due to heart failure.Kaplan-Meier curves revealed that compared to patients in the first tertile group of serum uric acid(<6.3 mg/dL),those in the highest tertile group(>8.5 mg/dL)had significantly higher rates of all-cause mortality,cardiovascular mortality,and the composite endpoint of cardiovascular mortality and heart failure hospitalization(P<0.001).However,with prolonged follow-up,there was an increasing trend in all-cause mortality endpoint events in the first tertile group compared to the second tertile group(6.3-8.5 mg/dL).After adjusting for clinical characteristics,etiology of heart failure,comorbidities,laboratory parameters,and medications using Cox regression models,an elevated unit uric acid level was significantly associated with increased risks of all-cause mortality[hazard ratio(HR)1.07,95%confrdence interval(CI)1.03-1.11,P<0.001],cardiovascular mortality(HR 1.07,95%CI 1.02-1.12,P=0.005),and the composite endpoint of cardiovascular mortalit

关 键 词：尿酸 心力衰竭 危险因素 全因死亡 心血管死亡 

分 类 号：R541.6[医药卫生—心血管疾病]