血尿酸白蛋白比值与急性冠脉综合征患者心脏机械循环辅助治疗预后的关系  

Relationship between serum uric acid to albumin ratio and prognosis of acute coronary syndrome patients undergoing cardiac mechanical circulatory support

作　　者：王潇 袁晓鹏 张传奇 崔启 李爽 郭鹏召 张静 党爱民 WANG Xiao;YUAN Xiaopeng;ZHANG Chuanqi;CUI Qi;LI Shuang;GUO Pengzhao;ZHANG Jing;DANG Aimin(Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People's Hospital,Zhengzhou,Henan 451464,China;Department of Cardiology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan 450007,China;Coronary Care Unit,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Cardiology,Dongguan Tungwah Hospital,Dongguan,Guangdong 523129,China;Department of Cardiology,Xuchang Central Hospital,Xuchang,Henan 461000,China;Department of Special Medical Treatment Center,Fuwai Hospital,Chinese Academy of Medical Sciences,National Center for Cardiovascular Diseases,Beijing 100037,China)

机构地区：[1]阜外华中心血管病医院河南省人民医院心脏中心,河南郑州451464 [2]郑州大学附属郑州中心医院心内科,河南郑州450007 [3]河南省人民医院冠心病重症监护室郑州大学人民医院,河南郑州450003 [4]东莞东华医院心内科,广东东莞523129 [5]许昌市中心医院心内科,河南许昌461000 [6]中国医学科学院阜外医院特需医疗中心国家心血管病中心,北京100037

出　　处：《中华实用诊断与治疗杂志》2025年第3期263-270,共8页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家重点研发计划(2022YFC3602405)。

摘　　要：目的 探讨行心脏机械循环辅助治疗(MCS)的急性冠脉综合征(ACS)患者发生心源性死亡的影响因素,探讨血尿酸白蛋白比值(sUAR)与其发生心源性死亡的关系。方法 2018年1月—2020年8月阜外华中心血管病医院行MCS治疗的ACS患者237例,以入院时sUAR中位数为界值分为低水平sUAR组(sUAR值≤9.93μmol/g)119例和高水平sUAR组(sUAR>9.93μmol/g)118例,比较2组入院时血压、心率、实验室指标、超声心动图指标、Grace评分、ACS类型、MCS类型等临床资料。2组入院后均给予冠心病二级预防用药及MCS或冠状动脉血运重建,并根据生命体征、合并症、并发症情况制定个体化药物治疗方案,记录住院期间、随访期间心源性死亡发生情况。采用单因素及多因素Cox回归分析行MCS治疗的ACS患者发生心源性死亡的影响因素。结果 (1)高水平sUAR组糖尿病(41.5%)、慢性肾功能不全(11.9%)、ST段抬高型急性心肌梗死(67.8%)、心肌梗死合并心源性休克(72.9%)、心肌梗死合并心脏骤停(19.5%)比例均高于低水平sUAR组(22.7%、4.2%、47.9%、60.5%、10.1%)(χ^(2)=4.718~20.057,P均<0.05),入院时心率[94.00(79.75,109.25)次/min]、空腹血糖[9.64(7.07,13.94)mmol/L]、血肌酐[112.00(84.50,155.50)μmol/L]、血尿酸[478.00(414.00,606.25)μmol/L]、肌钙蛋白[1 004.00(287.50,2 446.50)ng/L]、N末端脑钠肽前体[6 432.00(3 332.00,11 100.00)ng/L]和Grace评分[(203.68±40.82)分]均高于低水平sUAR组[80.00(70.00,91.00)次/min、6.69(5.53,9.70)mmol/L、72.00(61.00,94.00)μmol/L、272.00(227.00,328.00)μmol/L、171.00(23.00,1 493.00)ng/L、877.00(262.00,4 558.50)ng/L、(166.28±45.07)分](U=2.282~12.428,t=-6.694,P均<0.05),冠状动脉血运重建比例(72.9%)低于低水平sUAR组(84.9%)(χ^(2)=6.650,P=0.036),入院时收缩压[107.50(94.75,122.25)mmHg]、白蛋白[(35.27±5.15)g/L]、高密度脂蛋白胆固醇[(0.91±0.29)mmol/L]、左室射血分数[37.00%(27.50%,53.00%)]均低于低水平sUAR组[120.00(101.00,135.00)mmObjective To investigate the influencing factors of cardiac death in acute coronary syndrome(ACS)patients undergoing cardiac mechanical circulatory support(MCS),and to explore the relationship between serum uric acid to albumin ratio(sUAR)and cardiac death.Methods Totally 237 ACS patients underwent MCS in Fuwai Central China Cardiovascular Hospital from January 2018 to August 2020,and were divided into the low-level sUAR group(sUAR≤9.93μmol/g,n=119)and the high-level sUAR group(sUAR>9.93μmol/g,n=118)according to the median sUAR value on admission.The clinical data on admission such as blood pressure,heart rate,laboratory indicators,echocardiographic indicators,Grace score,ACS type,and MCS type were compared between two groups.After admission,both groups received secondary prevention medications for coronary heart disease and MCS or coronary revascularization,and individualized medication regimens were formulated according to vital signs,comorbidities and complications.The occurrences of cardiac death during hospitalization and follow-up were recorded.Univariate and multivariate Cox regression were used to analyze the influencing factors of cardiac death in ACS patients undergoing MCS.Results(1)The proportions of diabetes,chronic renal dysfunction,acute ST-segment elevation myocardial infarction,myocardial infarction with cardiac shock,and myocardial infarction with sudden cardiac arrest were higher in the high-level sUAR group(41.5%,11.9%,67.8%,72.9%,19.5%)than those in the low-level sUAR group(22.7%,4.2%,47.9%,60.5%,10.1%)(χ^(2)=4.718-20.057,all P values<0.05).The heart rate,fasting blood glucose,blood creatinine,blood uric acid,troponin,N-terminal pro-brain natriuretic peptide,and Grace score on admission were higher in the high-level sUAR group[94.00(79.75,109.25)beats/min,9.64(7.07,13.94)mmol/L,112.00(84.50,155.50)μmol/L,478.00(414.00,606.25)μmol/L,1004.00(287.50,2446.50)ng/L,6432.00(3332.00,11100.00)ng/L,203.68±40.82]than those in the low-level sUAR group[80.00(70.00,91.00)beats/min,6.69(5.53,9.70)mm

关 键 词：急性冠脉综合征 心脏机械循环辅助治疗 血尿酸/白蛋白比值 心源性死亡 

分 类 号：R541.4[医药卫生—心血管疾病]