高尿酸血症在冠状动脉非阻塞型心肌梗死预后中的预测价值

任飞; 魏腾飞; 涂胜

doi:10.16766/j.cnki.issn.1674-4152.002858

高尿酸血症在冠状动脉非阻塞型心肌梗死预后中的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.002858

亳州市人民医院心内科，安徽亳州 236800

基金项目:

安徽高校自然科学研究重点项目 KJ2020A0336

详细信息

通讯作者:
涂胜，E-mail：tusheng77@163.com

中图分类号: R542.22
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- 被引次数: 0
出版历程
- 收稿日期: 2022-04-18
- 网络出版日期: 2023-04-20

Hyperuricemia predicts adverse outcomes ater myocardial infarction with non-obstructive coronary arteries

Department of Cardiovascular Medicine, the People's Hospital of Bozhou, Bozhou, Anhui 236800, China

摘要

摘要: 目的探讨高尿酸血症与冠状动脉非阻塞型心肌梗死(MINOCA)患者的不良事件发生之间的潜在联系。方法选取2019年1月—2020年6月在亳州市人民医院心内科住院的急性心肌梗死行急诊冠脉造影并确诊为MINOCA的患者，共168例，根据血尿酸水平分为高尿酸血症组(47例)和正常尿酸组(121例)。由经过培训的心内科人员通过医院电子病历系统收集相关基线资料。平均随访18个月，通过门诊复诊、电话随访、调阅电子病历等方式记录出院后随访期间的主要心脑血管不良事件(MACCE)发生情况，并以此作为随访终点事件。比较2组患者基线资料，观察2组患者的预后差异。结果 168例患者共记录到35次MACCE。高尿酸血症组发生16次MACCE，正常尿酸组发生19次MACCE。与正常尿酸组相比，高尿酸血症组的MACCE和非致死性心肌梗死发生率更高(分别为34.0% vs. 15.7%和10.6% vs. 0.8%；均P < 0.05)。Kaplan-Meier生存分析曲线表明，高尿酸血症组MACCE风险与正常尿酸组生存曲线逐渐分离，且二者差异有统计学意义(log-rank P=0.003)。结论对于MINOCA患者来说，高尿酸血症与其不良事件发生密切相关，且很可能是MINOCA患者MACCE事件发生的独立预测因子。血尿酸水平有望作为预测MINOCA患者预后的生物学标志物。
- 高尿酸血症 /
- 心肌梗死 /
- 预测
Abstract: Objective This study aimed to investigate the potential association between hyperuricemia and the adverse outcomes in myocardial infarction with non-obstructive coronary arteries (MINOCA) patients. Methods A total of 168 patients diagnosed with acute myocardial infarction who underwent emergency coronary angiography and were diagnosed as MINOCA in the Department of Cardiology of the People's Hospital of Bozhou from January 2019 to June 2020 were enrolled, and were divided into two groups based on the level of serum creatinine: hyperuricemia group (47 cases) and normouricemia group (121 cases). Follow-up was carried out for 18 months after discharge through outpatient visits, telephone calls, reviewing electronic medical records and clinical notes by two experienced cardiologists to obtain patient's clinical status and major adverse cardiovascular and cerebrovascular events (MACCE) or the first reported outcome case. The study also aimed to explore the association between hyperuricemia and adverse outcomes in MINOCA patients. Results All patients had follow-up data, of which 35 MACCE were recorded. The hyperuricemia group was associated with 16 MACCE, whereas 19 MACCE occurred in the normouricemia group. The hyperuricemia group had a higher incidence of MACCE and nonfatal myocardial infarction (MI) compared with the normouricemia group (34.0% vs. 15.7% and 10.6% vs. 0.8%, respectively; both P < 0.05). The increased risk of MACCE in the hyperuricemia group is shown in Kaplan-Meier survival curves, which demonstrated that MINOCA patients within the hyperuricemia group were clearly different from those in the normouricemia group, and this difference is statistically significant (log-rank P=0.003). Conclusion Hyperuricemia is associated with adverse outcomes and appears to be an independent predictor of MACCE in MINOCA patients. This finding indicates that the serum uric acid levels may serve as a surrogate biomarker related to risk prediction and adverse outcomes of MINOCA patients.
- Hyperuricemia /
- Myocardial infarction /
- Predict

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图 1 高尿酸血症组与正常尿酸组MINOCA患者的MACCE生存分析曲线

Figure 1. MACCE survival of MINOCA patients in hyperuricemia group and normal uric acid group

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表 1 2组MINOCA患者基线资料比较

Table 1. Comparison of baseline data in 2 groups of MINOCA patients

组别	例数	年龄 (x±s, 岁)	性别[例(%)]		高血压 [例(%)]	糖尿病 [例(%)]	吸烟史 [例(%)]	BMI (x±s)	心房颤动 [例(%)]	eGFR (mL/min)
组别	例数	年龄 (x±s, 岁)	女性	男性	高血压 [例(%)]	糖尿病 [例(%)]	吸烟史 [例(%)]	BMI (x±s)	心房颤动 [例(%)]	eGFR (mL/min)
高尿酸血症组	47	56.51±12.24	15(31.9)	32(68.1)	32(68.1)	7(14.9)	17(36.2)	24.68±2.95	3(6.4)	67.17±23.52
正常尿酸组	121	59.56±10.75	36(29.8)	85(70.2)	73(60.3)	14(11.6)	35(28.9)	24.63±2.95	7(5.8)	63.20±19.12
统计量		1.588^a	0.075^b		0.869^b	0.342^b	0.831^b	0.087^a	0.022^b	1.130^a
P值		0.114	0.784		0.351	0.559	0.362	0.931	0.999	0.260

组别	例数	LVEF (x±s, %)	STEMI [例(%)]	收缩压 (x±s, mm Hg)	舒张压 (x±s, mm Hg)	心率 (x±s, 次/min)		利尿剂使用	冠脉造影数据[例(%)]
组别	例数	LVEF (x±s, %)	STEMI [例(%)]	收缩压 (x±s, mm Hg)	舒张压 (x±s, mm Hg)	心率 (x±s, 次/min)		利尿剂使用	正常冠状动脉(无狭窄)	轻度冠状动脉狭窄(狭窄 < 50%)
高尿酸血症组	47	53.94±5.77	15(31.9)	144.23±23.68	87.32±14.89	79.28±11.20		6(12.8)	16(34.0)	31(66.0)
正常尿酸组	121	54.36±6.63	28(23.1)	139.22±22.92	83.36±14.99	74.42±13.32		7(5.8)	46(38.1)	75(61.9)
统计量		0.388^a	1.369^b	1.260^a	1.538^a	2.213^a		1.436^b	0.230^b
P值		0.699	0.242	0.209	0.126	0.028		0.231	0.632
注：^a为t值，^b为χ²值。1 mm Hg=0.133 kPa。

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表 2 2组MINOCA患者相关实验室结果比较

Table 2. Comparison of laboratory results in 2 groups of MINOCA patients

组别	例数	UA (x±s, μmol/L)	cTnI [M(P₂₅, P₇₅), ng/mL]	NT-proBNP [M(P₂₅, P₇₅), pg/mL]	TC (x±s, mmol/L)	TG (x±s, mmol/L)	HDL-C (x±s, mmol/L)	LDL-C (x±s, mmol/L)
高尿酸血症组	47	450.44±71.86	1.68(0.49, 6.65)	222.00(80.00, 880.00)	4.32±1.07	2.10±1.32	1.14±0.31	2.54±0.92
正常尿酸组	121	293.54±75.19	1.03(0.28, 5.21)	236.00(99.70, 529.75)	4.09±0.98	1.89±1.80	1.16±0.25	2.37±0.81
统计量		12.146^a	2 499.000^b	2 813.500^b	1.297^a	0.753^a	0.284^a	1.182^a
P值		＜0.001	0.223	0.982	0.197	0.452	0.777	0.239
注：^a为t值，^b为U值。

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表 3 2组患者随访期间MACCE比较[例(%)]

Table 3. Comparison of MACCE between the two groups during follow-up [cases (%)]

组别	例数	MACCE	心血管死亡	非致死性心肌梗死	心力衰竭	卒中	心绞痛再住院
高尿酸血症组	47	16(34.0)	3(6.4)	5(10.6)	2(4.3)	2(4.3)	4(8.6)
正常尿酸血症组	121	19(15.7)	4(3.3)	1(0.8)	3(2.4)	2(1.6)	6(4.9)
χ²值		6.904	0.217	6.828	0.010	0.184	0.260
P值		0.009	0.641	0.009	0.918	0.668	0.610

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表 4 MACCE预测因素的单因素和多因素logistic回归分析

Table 4. Univariate and multivariate logistic regression analysis of MACCE predictors

变量	B	SE	Wald χ²	P值	OR(95% CI)
单因素分析
性别(女性)	-0.064	0.410	0.024	0.877	0.938(0.420~2.097)
年龄	-0.004	0.017	0.047	0.828	0.996(0.964~1.030)
高血压病	0.680	0.425	2.561	0.110	1.975(0.858~4.543)
糖尿病	1.006	0.497	4.094	0.043	2.735(1.032~7.249)
房颤	-0.054	0.814	0.004	0.947	0.947(0.192~4.673)
心率	0.030	0.015	4.327	0.038	1.031(1.002~1.061)
LVEF	-0.073	0.029	6.319	0.012	0.929(0.878~0.984)
BMI	0.045	0.065	0.467	0.494	1.046(0.920~1.189)
eGFR	-0.002	0.006	0.116	0.733	0.998(0.986~1.010)
高尿酸血症	1.019	0.396	6.607	0.010	2.771(1.274~6.027)
利尿剂使用	0.142	0.688	0.043	0.836	1.153(0.300~4.437)
多因素分析
LVEF	-0.076	0.030	6.425	0.011	0.927(0.875~0.983)
高尿酸血症	1.014	0.407	6.210	0.013	2.757(1.242~6.120)
注：赋值方法如下，性别(男=0，女=1)；高血压病、糖尿病、房颤、吸烟均为有=1，无=0；高尿酸血症(正常尿酸组=0，高尿酸组=1)；利尿剂使用(使用=1，未使用=0)；MACCE(有=1，无=0)；其余连续变量以实际值赋值。

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