真实世界患者中替格瑞洛对血清尿酸水平的影响  

Impact of ticagrelor on serum uric acid levels in real-world

作　　者：周子涵 刘德敏[1] 陈慧[2] 姚一鸣 王倩[1] 耿雪[1] 刘阔 崔炜[1] Zhou Zihan;Liu Demin;Chen Hui;Yao Yiming;Wang Qian;Geng Xue;Liu Kuo;Cui Wei(Department of Cardiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Data Center,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心内科,石家庄050000 [2]河北医科大学第二医院数据中心,石家庄050000

出　　处：《中国心血管杂志》2025年第1期28-34,共7页Chinese Journal of Cardiovascular Medicine

摘　　要：目的明确真实世界患者接受替格瑞洛治疗后血清尿酸水平的变化及血清尿酸升高的发生率,并进一步探讨影响替格瑞洛相关血清尿酸升高的危险因素。方法单中心、横断面研究。连续入选2015年1月至2023年10月于河北医科大学第二医院电子病历系统登记的多次住院并应用双联抗血小板药物治疗的患者11778例(其中男性8219例,69.8%),分为氯吡格雷组6492例和替格瑞洛组5286例。收集患者的基线临床资料和再次住院时的血清尿酸水平。使用倾向性评分匹配(PSM)对两组患者的基线资料和影响尿酸水平变化的因素进行校正,分别比较两组患者用药后尿酸水平的变化及尿酸升高的发生率。将替格瑞洛用药患者血清尿酸升高(2552例)与未升高(2734例)两组单因素分析中P<0.05的变量,纳入多因素logistic回归分析替格瑞洛相关血清尿酸水平升高的独立危险因素,根据受试者工作特征(ROC)曲线评估上述危险因素对血清尿酸水平升高的预测价值。结果替格瑞洛组和氯吡格雷组的基线和用药后血清尿酸水平比较,差异均有统计学意义(均为P<0.001)。为了平衡基线混杂因素,对两组患者按1∶1比例进行PSM分析。经匹配后,替格瑞洛组用药后血清尿酸水平高于氯吡格雷组,差异有统计学意义[(339.27±101.54)μmol/L比(328.43±96.68)μmol/L,t=5.471,P<0.001];替格瑞洛组用药后尿酸升高的绝对值和百分比均高于氯吡格雷组,差异均有统计学意义[(10.54±88.87)μmol/L比(1.56±82.39)μmol/L,t=5.242,P<0.001;6.8%±47.0%比3.5%±27.7%,t=4.364,P<0.001];此外,替格瑞洛组血清尿酸升高发生率高于氯吡格雷组,差异有统计学意义(48.4%比41.9%,χ^(2)=43.146,P<0.001)。Logistic回归分析显示,体重(OR=1.011,95%CI:1.006~1.017)、基线肌酐水平(OR=1.010,95%CI:1.006~1.013)和袢利尿剂(OR=1.548,95%CI:1.172~2.044)为替格瑞洛组血清尿酸升高的独立危险因素;而再次住院间隔时间(OR=1.000Objective To clarify the changes and the incidence of elevation in serum uric acid levels in real-world patients treated with ticagrelor,and to further explore the risk factors associated with ticagrelor-related serum uric acid elevation.Methods This was a single-center,cross-sectional study.A total of 11778 patients(8219 males,69.8%)who were admitted multiple times to the Second Hospital of Hebei Medical University between January 2015 and October 2023,and were registered in the electronic medical record system with dual antiplatelet therapy,were included in this study.Patients were divided into clopidogrel group(6492 cases)or ticagrelor group(5286 cases).Baseline clinical data and serum uric acid levels during subsequent admissions were collected.Propensity score matching(PSM)was used to adjust for baseline data and factors affecting changes in uric acid levels between two groups.The change of serum uric acid and the incidence of elevation in serum uric acid levels were compared between groups.Variables with P<0.05 in univariate analysis between ticagrelor-related serum uric acid elevation group(2552 cases)and non-elevation group(2734 cases)were included in multivariate logistic regression analysis to identify the independent risk factors for ticagrelor-related serum uric acid elevation.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the above risk factors.Results The comparison of baseline and post-medication serum uric acid levels between ticagrelor and clopidogrel groups showed statistically significant differences(all P<0.001).In order to balance the baseline confounding factors,a PSM analysis was conducted at a 1∶1 ratio between two groups.After matching,post-medication uric acid level in ticagrelor group was higher than that in clopidogrel group[(339.27±101.54)μmol/L vs.(328.43±96.68)μmol/L,t=5.471,P<0.001].The absolute and percentage increase in uric acid levels post-medication were significantly higher in ticagrelor group compared to clopidogrel group,[

关 键 词：替格瑞洛 尿酸 真实世界研究 

分 类 号：R54[医药卫生—心血管疾病]