摘要
目的分析血尿酸水平与非ST段抬高型急性冠脉综合征(NSTE-ACS)患者冠状动脉病变严重程度及预后的关系。方法选取2013年1月—2016年5月于新泰市人民医院行经皮冠状动脉介入术(PCI)的NSTE-ACS患者268例,根据血尿酸水平分为低尿酸组93例(血尿酸水平<315.92μmol/L,n=93)、中尿酸组(血尿酸水平315.92~395.70μmol/L,n=88)、高尿酸组(血尿酸水平>395.70μmol/L,n=87);根据随访期间主要不良心脑血管事件(MACCE)发生情况分为MACCE组45例与非MACCE组223例。比较低尿酸组、中尿酸组、高尿酸组患者临床特征、药物使用情况、实验室检查指标及MACCE发生率,MACCE组、非MACCE组患者临床特征、药物使用情况及实验室检查指标;血尿酸水平与NSTE-ACS患者Syntax评分的相关性分析采用Pearson相关性分析,NSTE-ACS患者MACCE的影响因素分析采用Cox比例风险回归模型分析;比较低尿酸组、中尿酸组、高尿酸组患者无事件生存率。结果 (1)低尿酸组、中尿酸组、高尿酸组患者性别、年龄、冠心病家族史、高血压病史、吸烟史及阿司匹林、氯吡格雷、他汀类药物、血管紧张素转换酶抑制剂(ACEI)、β-受体阻滞剂、钙通道阻滞剂、硝酸酯类药物使用率比较,差异无统计学意义(P>0.05);中尿酸组、高尿酸组患者糖尿病病史阳性率、Syntax评分高于低尿酸组,高尿酸组患者糖尿病病史阳性率、Syntax评分高于中尿酸组(P<0.05)。低尿酸组、中尿酸组、高尿酸组患者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、肌酐(Cr)水平比较,差异无统计学意义(P>0.05)。中尿酸组、高尿酸组患者MACCE发生率高于低尿酸组,高尿酸组患者MACCE发生率高于中尿酸组(P<0.05)。(2)Pearson相关性分析结果显示,血尿酸水平与NSTE-ACS患者Syntax评分呈正相关(r=0.520,P<0.05)。(3)MACCE组与非MACCE组患者性别,冠心病家族史,吸烟史,阿司匹林、氯吡格雷、他汀类药物、ACEI、β-受体阻滞剂、钙通道阻滞剂、硝酸酯类药物使用率,TC、TG、HDL、Cr水平比较,差异无统计学意义(P>0.05);MACCE组与非MACCE组患者年龄、高血压病史、糖尿病病史、Syntax评分、LDL水平、血尿酸水平比较,差异有统计学意义(P<0.05)。(4)Cox比例风险回归模型分析结果显示,年龄[HR=5.068,95%CI(1.485,17.303)]、高血压病史[HR=1.114,95%CI(1.018,1.219)]、糖尿病病史[HR=0.141,95%CI(1.021,1.276)]、血尿酸水平[HR=4.007,95%CI(1.184,13.559)]是NSTE-ACS患者MACCE的影响因素(P<0.05)。(5)低尿酸组患者无事件生存率高于中尿酸组、高尿酸组,中尿酸组患者无事件生存率高于高尿酸组(P<0.05)。结论血尿酸水平与NSTE-ACS患者冠状动脉病变严重程度有关,是NSTE-ACS患者MACCE的影响因素,且血尿酸水平>395.70μmol/L的NSTE-ACS患者MACCE发生风险较高。
Objective To analyze the relations of blood uric acid(BUA)level with severity of coronary artery disease and prognosis in patients with non ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods A total of 268 NSTE-ACS patients undergoing PCI were selected in the People's Hospital of Xintai from January 2013 to May 2016,and they were divided into low-BUA group(with BUA level less than 315.92μmol/L,n=93),medium-BUA group(with BUA level equal or over 315.92 but equal or less than 395.70μmol/L,n=88)and high-BUA group(with BUA level over 395.70μmol/L,n=87)according to BUA level;into MACCE group(n=45)and non-MACCE group(n=223)according to the incidence of MACCE during follow-up.Clinical features,drugs usage,laboratory examination results and incidence of MACCE were compared in low-BUA group,medium-BUA group and high-BUA group,clinical features,drugs usage and laboratory examination results were compared between MACCE group and non-MACCE group;Pearson correlation analysis was used to analyze the correlation between BUA level and Syntax score in patients with NSTE-ACS,and Cox proportional hazard regression model was used to analyze the influencing factors of MACCE in patients with NSTE-ACS;event free survival rate was compared in low-BUA group,medium-BUA group and high-BUA group.Results (1)No statistically significant differences of gender,age,family history of coronary heart disease,medical history of hypertension,smoking history,usage rate of aspirin,clopidogrel,statins,ACEI,β-receptor blockers,calcium channel blockers or nitrate lipids was found in low-BUA group,medium-BUA group and high-BUA group(P>0.05);positive rate of diabetes history and Syntax score in medium-BUA group and high-BUA group were statistically significantly higher than those in low-BUA group(P<0.05),meanwhile positive rate of diabetes history and Syntax score in high-BUA group were statistically significantly higher than those in medium-BUA group(P<0.05).No statistically significant differences of levels of TC,TG,LDL,HDL or Cr was found in low-BUA group,medium-BUA group and high-BUA group(P>0.05).Incidence of MACCE in medium-BUA group and high-BUA group was statistically significantly higher than that in low-BUA group,respectively(P<0.05),meanwhile incidence of MACCE in high-BUA group was statistically significantly higher than that in medium-BUA group(P<0.05).(2)Pearson correlation analysis results showed that,BUA level was positively correlated with Syntax score in patients with NSTE-ACS(r=0.520,P<0.05).(3)No statistically significant differences of gender,family history of coronary heart disease,smoking history,usage rate of aspirin,clopidogrel,statins,ACEI,β-receptor blockers,calcium channel blockers or nitrate lipids and levels of TC,TG,HDL or Cr was found between MACCE group and non-MACCE group(P>0.05),while there were statistically significant differences of age,medical history or hypertension and diabetes,Syntax score,LDL and BUA level between MACCE group and non-MACCE group(P<0.05).(4)Cox proportional hazard regression model analysis results showed that,age〔HR=5.068,95%CI(1.485,17.303)〕,medical history of hypertension〔HR=1.114,95%CI(1.018,1.219)〕and diabetes〔HR=0.141,95%CI(1.021,1.276)〕,and BUA level〔HR=4.007,95%CI(1.184,13.559)〕were influencing factors of MACCE in patients with NSTE-ACS(P<0.05).(5)Event free survival rate in low-BUA group was statistically significantly higher than that in medium-BUA group and high-BUA group,respectively,meanwhile event free survival rate in medium-BUA group was statistically significantly higher than that in high-BUA group(P<0.05).Conclusion BUA level is significantly correlated with the severity of coronary artery disease in patients with NSTE-ACS,and is one of influencing factors of MACCE,meanwhile risk of MACCE is significantly increased in NSTE-ACS patients with BUA level over 395.70μmol/L.
作者
张越
李军
ZHANG Yue;LI Jun(School of Medicine and Life Sciences,University of Ji'nan-Shandong Academy of Medical Sciences,Ji'nan 250022,China;Institute of Materia Medica,Shandong Academy of Medical Sciences,Ji'nan 250062,China;Key Laboratory for Biotech-Drugs,Ministry of Health,Ji'nan 250062,China;The People's Hospital of Xintai,Xintai 271200,China)
出处
《实用心脑肺血管病杂志》
2018年第2期28-33,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
急性冠脉综合征
尿酸
预后
Acute coronary syndrome
Uric acid
Prognosis
