摘要
目的探讨急性心力衰竭(心衰)患者血清尿酸水平与其近2年的预后关系。方法选取2015年1月至2017年1月于中国人民解放军第85医院随诊的急性心衰或慢性心衰急性发作患者200例作为研究对象,随访2年,按是否发生主要不良心脏事件(MACE)分为预后不良组(61例)和预后良好组(139例),比较两组患者血清尿酸水平及其他相关指标的差异,分析MACE发生的危险因素及尿酸对MACE的预测价值。结果预后不良组患者血清尿酸水平、N末端脑钠肽前体(NT-proBNP)水平及年龄、NHYA分级Ⅲ/Ⅳ级比例明显高于预后良好组(P均<0.05),而左心室射血分数(LVEF)水平明显低于预后良好组(P<0.05)。Logistic多因素回归分析显示尿酸、NT-proBNP可能是患者MACE的危险因素,LVEF可能是保护因素(P均<0.05)。尿酸预测男性患者MACE的ROC曲线下面积为0.840(95%CI:0.759~0.903,P<0.001),准确度为0.681,截点值为467.45μmol/L,敏感性和特异性分别为77.14%、90.91%;尿酸预测女性患者发生MACE的ROC曲线下面积为0.703(95%CI:0.596~0.796,P<0.001),准确度为0.614,截点值为386.27μmol/L,敏感性和特异性分别为75.53%、85.87%。结论血清尿酸对急性心衰患者近2年发生MACE的预测价值较高,临床中可据此早期给予干预措施改善患者预后。
Objective To discuss the relationship between level of serum uric acid(UA)and prognosis in patients with acute heart failure(AHF)in recent 2 years.Methods The patients with AHF or acute attack of chronic heart failure(n=200)were chosen and followed up from Chinese PLA 85th Hospital from Jan.2015 to Jan.2017.All patients were divided,according to the incidence of major adverse cardiac events(MACE),into poor prognosis group(n=61)and good prognosis group(n=139).The difference in serum UA level and other relevant indexes was compared between 2 groups,and MACE risk factors and predictive value of UA to MACE were analyzed.Results The levels of serum UA and N-terminal pro-brain natriuretic peptide(NT-proBNP),age,percentage of cases of NHYA gradesⅢorⅣwere significantly higher,and level of left ventricular ejection fraction(LVEF)was significantly lower in poor prognosis group than those in good prognosis group(P<0.05).The results of multi-factor Logistic regression analysis showed that UA and NT-proBNP were possible risk factors of MACE,and LVEF was a protective factor(P<0.05).The area under the ROC curve of UA predicting MACE in male patients was 0.840(95%CI:0.759~0.903,P<0.001),accuracy was 0.681,cut-off point value was 467.45μmol/L,sensitivity was 77.14%and specificity was 90.91%.The area under the ROC curve of UA predicting MACE in female patients was 0.703(95%CI:0.596~0.796,P<0.001),accuracy was 0.614,cut-off point value was 386.27μmol/L,sensitivity was 75.53%and specificity was 85.87%.Conclusion The level of serum UA has higher predictive value to MACE incidence in AHF patients in recent 2 years,and early interventional measures can be taken for patients to improve their prognosis.
作者
吴炎
王亚年
蒲红
Wu Yan;Wang Yanian;Pu Hong(Department of Cardiology,Chinese PLA 85th Hospital,Shanghai 200052,China;不详)
出处
《中国循证心血管医学杂志》
2020年第9期1094-1097,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
上海市卫生和计划生育委员会科研课题(M20170089)。
关键词
急性心力衰竭
尿酸
主要不良心脏事件
预测价值
预后
Acute heart failure
Uric acid
Major adverse cardiac events
Predictive value
Prognosis
