尿酸白蛋白比值对冠状动脉慢性完全闭塞患者中远期全因死亡的预测价值

张晶晶; 赵宇飞; 朱华良; 祝小霞; 刘泽岩; 黄正

doi:10.16766/j.cnki.issn.1674-4152.003667

尿酸白蛋白比值对冠状动脉慢性完全闭塞患者中远期全因死亡的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.003667

1.
安徽医科大学第二附属医院老年心血管内科，安徽合肥 230011
2.
安徽医科大学第二附属医院急诊内科
3.
安徽医科大学第二附属医院心血管内科

基金项目:

安徽省高等学校自然科学研究重点项目 2022AH050770

详细信息

通讯作者:
黄正，E-mail：hz61364312@126.com

中图分类号: R543.31
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出版历程
- 收稿日期: 2024-01-30

The predictive value of uric acid to albumin ratio for medium and long-term all-cause mortality in patients with CTO

1.
Cardiovascular Department for Gerontism, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230011, China

摘要

摘要: 目的探讨尿酸白蛋白比值(UAR)能够反映机体的炎症和氧化状态，分析其在冠状动脉慢性闭塞(CTO)患者中的表达水平，并评估其对患者中远期死亡的预判价值。方法选取2019年1月—2023年3月安徽医科大学第二附属医院行冠脉造影的CTO患者259例，根据患者的预后情况将其分为存活组和死亡组，入院行冠脉造影前计算UAR。应用单因素回归分析和多因素logistic回归分析评估UAR对CTO患者死亡不良事件的影响。结果本研究随访期[(39.9±12.3)个月]内，259例CTO患者中有39例(15.06%)死亡，220例(84.94%)存活。与存活组比较，死亡组患者的年龄更大，CTO双支病变比例更高，尿素氮、肌酐、尿酸、UAR及中性粒细胞-淋巴细胞比值(NLR)水平更高，完全血运重建例数更少，白蛋白及甘油三酯水平更低，差异均有统计学意义(P＜0.05)。多因素logistic回归分析显示，CTO患者预后不良的危险因素包括年龄增长、CTO病变数量增多及UAR增高。UAR预测CTO患者中远期全因死亡的ROC曲线下面积为0.648(95% CI：0.547~0.748，P=0.003)，灵敏度为53.8%，特异度为72.7%。结论与生存者相比，死亡的CTO患者UAR明显增高，UAR对冠状动脉慢性完全闭塞患者中远期全因死亡具有一定的预测价值。
- 尿酸白蛋白比值 /
- 冠状动脉慢性完全闭塞 /
- 回归分析
Abstract: Objective Uric acid to albumin ratio (UAR) can reflect the inflammation and oxidation status, this study was to analyze its expression level in patients with chronic coronary artery occlusion (coronary chronic total occlusion, CTO), and evaluate its prediction value for long-term death in patients. Methods A total of 259 CTO patients undergoing coronary angiography in the Second Affiliated Hospital of Anhui Medical University from January 2019 to March 2023 were selected, and the patients were divided into survival group and death group according to their prognosis. Univariate regression analysis and multivariate logistic regression analysis were used to evaluate the effect of UAR on mortality adverse events in CTO patients. Results Among the 259 CTO patients, 39 (15.06%) died and 220 (84.94%) survived during the follow-up period of approximately of (39.9±12.3) months. Compared with the survival group, patients in the death group exhibited a older age, higher proportion of dual -vessel lesions of CTO, higher levels of blood urea nitrogen, creatinine, uric acid, UAR, and neutrophil-to-lymphocyte ratio (NLR), fewer cases of complete revascularization, and lower levels of albumin and triglycerides (P < 0.05). Multivariate logistic regression analysis showed that the risk factors for poor prognosis in CTO patients include increasing age, increased number of CTO lesions and elevated UAR. The area under the ROC curve for UAR predicting mid to long-term all-cause mortality in CTO patients was 0.648 (95% CI: 0.547-0.748, P=0.003), with a sensitivity of 53.8% and a specificity of 72.7%. Conclusion The UAR of the deceased is significantly higher compared to survivors, indicating that UAR holds certain predictive value for mid to long-term all-cause mortality in patients with chronic total occlusion of the coronary arteries.
- Uric acid to albumin ratio /
- Chronic total occlusion of coronary arteries /
- Regression analysis
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图 1 UAR预测CTO患者中远期全因死亡预测价值的ROC曲线

Figure 1. ROC curve of UAR in predicting mid- and long-term all-cause mortality in CTO patients

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表 1 存活组与死亡组CTO患者一般资料和临床资料比较

Table 1. Comparison of general and clinical characteristics between the survival group and the death group

项目	存活组(n=220)	死亡组(n=39)	统计量	P值
性别[例(%)]
男性	145(65.91)	29(74.36)	1.070^a	0.357
女性	75(34.09)	10(25.64)
年龄[M(P₂₅, P₇₅), 岁]	66(57, 72)	73(66, 79)	-4.030^b	＜0.001
血管病变数量[M(P₂₅, P₇₅), 根]	2(1，3)	2(2，3)	-1.899^b	0.058
CTO病变血管数量[例(%)]
单支	201(91.36)	29(74.36)	8.000^a	0.005
双支	19(8.64)	10(25.64)
CTO病变部位[例(%)]
前降支	77(35.00)	15(38.46)	0.173^a	0.677
回旋支	60(27.27)	10(25.64)	0.045^a	0.833
右冠脉	99(45.00)	22(56.41)	1.733^a	0.188
CTO成功开通例数[例(%)]	152(69.09)	22(56.41)	3.096^a	0.267
血管完全重建例数[例(%)]	93(42.27)	8(20.51)	7.446^a	0.017
左心室射血分数[M(P₂₅, P₇₅), %]	58(42, 63)	60(48, 62)	-0.596^b	0.551
糖尿病[例(%)]	78(35.45)	16(41.03)	0.445^a	0.505
高血压[例(%)]	167(75.91)	28(71.79)	0.301^a	0.583
吸烟[例(%)]	45(20.45)	13(33.33)	3.162^a	0.075
尿素氮[M(P₂₅, P₇₅)，mmol/L]	6.13(4.99, 7.53)	7.12(5.63, 9.15)	-2.447^b	0.014
肌酐[M(P₂₅, P₇₅), μmol/L]	77.00(63.00, 90.00)	100.50(74.00，118.00)	-3.749^b	＜0.001
尿酸[M(P₂₅, P₇₅)，μmol/L]	319.00(260.25, 383.75)	349.00(295.00, 408.00)	-1.966^b	0.049
白蛋白(x±s，g/L)	40.01±4.01	37.72±5.10	3.148^c	0.002
胆固醇[M(P₂₅, P₇₅)，mmol/L]	4.25(3.49, 5.03)	4.38(3.66, 5.41)	-0.921^b	0.357
甘油三酯[M(P₂₅, P₇₅)，mmol/L]	1.490(1.030, 2.190)	1.245(0.950, 1.720)	-1.983^b	0.047
高密度脂蛋白[M(P₂₅, P₇₅)，mmol/L]	1.03(0.89, 1.27)	1.07(0.87, 1.24)	-0.065^b	0.949
低密度脂蛋白[M(P₂₅, P₇₅)，mmol/L]	2.50(1.87, 3.09)	2.72(2.03, 3.46)	-1.609^b	0.108
UAR[M(P₂₅, P₇₅)]	8.10(6.50, 9.70)	9.50(7.10, 11.40)	-2.937^b	0.003
PLR[M(P₂₅, P₇₅)]	118.39(89.52，154.02)	122.26(88.73, 180.35)	-0.567^b	0.570
NLR[M(P₂₅, P₇₅)]	2.35(1.70, 3.13)	2.50(2.04, 3.91)	-2.294^b	0.022
Gensini积分[M(P₂₅, P₇₅)，分]	64.00(48.00, 86.00)	67.50(47.13, 96.25)	-0.463^b	0.644
注：^a为χ²值，^b为Z值，^c为t值。

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表 2 影响CTO患者全因死亡的单因素logistic回归分析

Table 2. Univariate logistic regression analysis of factors influencing all-cause mortality in CTO patients

变量	B	SE	Waldχ²	P值	OR(95% CI)
年龄	0.074	0.020	13.229	＜0.001	1.077(1.035~1.120)
CTO病变数量	1.294	0.438	8.719	0.003	3.648(1.545~8.612)
血管完全重建	-1.056	0.417	6.407	0.011	0.348(0.154~0.788)
尿素氮	0.153	0.055	7.733	0.005	1.165(1.046~1.297)
肌酐	0.002	0.002	2.218	0.136	1.002(0.999~1.005)
甘油三酯	-0.315	0.192	2.693	0.101	0.730(0.501~1.063)
UAR	0.261	0.073	12.702	＜0.001	1.298(1.125~1.499)
NLR	0.091	0.048	3.615	0.057	1.095(0.997~1.202)

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表 3 影响CTO患者全因死亡的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis affecting all-cause mortality in CTO patients

变量	B	SE	Waldχ²	P值	OR(95% CI)
年龄	0.065	0.020	9.920	0.002	1.067(1.025~1.110)
CTO病变数量	1.035	0.467	4.904	0.027	2.814(1.126~7.032)
UAR	0.239	0.076	9.818	0.002	1.270(1.093~1.474)

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参考文献(21)

[1]	ALLAHWALA U K, NOUR D, BHATIA K, et al. Prognostic impact of collaterals in patients with a coronary chronic total occlusion: a meta-analysis of over 3, 000 patients[J]. Catheter Cardiovasc Interv, 2021, 97(6): E771-E777.
[2]	OFLAR E, YILDIZ C, KOYUNCU A, et al. Relationship between uric acid albumin ratio and peripheral artery disease complexity[J]. Eur Rev Med Pharmacol Sci, 2023, 27(23): 11472-11478.
[3]	SELÇUK M, ÇINAR T, ŞAYLIK F, et al. Predictive value of uric acid/albumin ratio for the prediction of new-onset atrial fibrillation in patients with ST-elevation myocardial infarction[J]. Rev Invest Clin, 2022, 74(3): 156-164.
[4]	ZHANG Y S, XU Z R, HE W F, et al. Elevated serum uric acid/albumin ratio as a predictor of post-contrast acute kidney injury after percutaneous coronary intervention in patients with ST-Segment elevation myocardial infarction[J]. J Inflamm Res, 2022, 15: 5361-5371. doi: 10.2147/JIR.S377767
[5]	ADALI M K, BUBER I, SEN G, et al. Relationship between systemic immune-inflammation index and coronary collateral circulation in patients with chronic total occlusion[J]. Arq Bras Cardiol, 2022, 119(1): 69-75.
[6]	徐夏莲, 许佳瑞, 王一梅, 等. 术前血尿酸水平对心脏手术术后急性肾损伤发生的影响[J]. 中国临床医学, 2019, 26(3): 450-455. XU X L, XU J R, WANG Y M, et al. Effect of preoperative serum uric acid on the risk of the acute kidney injury after cardiac surgery[J]. Chinese Journal of Clinical Medicine, 2019, 26(3): 450-455.
[7]	李双双, 马依彤, 吴婷婷, 等. 基线血红蛋白水平对老年冠心病患者远期临床预后的影响[J]. 临床内科杂志, 2023, 40(9): 598-602. LI S S, MA Y T, WU T T, et al. Effect of baseline hemoglobin levels on long-term clinical outcome in elderly patients with coronary heart disease[J]. Journal of Clinical Internal Medicine, 2023, 40(9): 598-602.
[8]	YANG Y, ZHANG X Y, JIN Z G, et al. Association of serum uric acid with mortality and cardiovascular outcomes in patients with hypertension: a meta-analysis[J]. J Thromb Thrombolysis, 2021, 52(4): 1084-1093.
[9]	AYOUB M, MASHAYEKHI K, BEHNES M, et al. Prognostic value of different levels of uric acid in patients with coronary chronic total occlusion undergoing percutaneous coronary intervention[J]. J Clin Med, 2023, 12(11): 3794. DOI: 10.3390/jcm12113794.
[10]	CUI K Y, SONG Y J, YIN D, et al. Uric Acid Levels, number of standard modifiable cardiovascular risk factors, and prognosis in patients with coronary artery disease: a large cohort study in Asia[J]. J Am Heart Assoc, 2023, 12(20): e030625. DOI: 10.1161/JAHA.123.030625.
[11]	YAN X J, GONG J, WANG Z W, et al. Serum uric acid was non-linearly associated with the risk of all-cause and cardiovascular death in individuals with coronary heart disease: a large prospective cohort study[J]. Front Endocrinol (Lausanne), 2023, 14: 1278595. DOI: 10.3389/fendo.2023.1278595.
[12]	MANOLIS A A, MANOLIS T A, MELITA H, et al. Low serum albumin: a neglected predictor in patients with cardiovascular disease[J]. Eur J Intern Med, 2022, 102: 24-39.
[13]	BC P K, SOMANNAVAR V G. A study on the role of serum calcium, serum albumin and serum uric acid as markers of initial neurological severity and short term outcome indicators in acute ischemic stroke[J]. J Assoc Physicians India, 2022, 70(4): 11-12.
[14]	康云鹏, 郭雯, 任爱红, 等. 营养风险对老年射血分数减低型心力衰竭患者住院期间体适能的影响[J]. 中华全科医学, 2023, 21(6): 932-935, 944. doi: 10.16766/j.cnki.issn.1674-4152.003018 KANG Y P, GUO W, REN A H, et al. Effect of nutritional risk on physical fitness during hospitalization in elderly patients with reduced ejection fraction heart failure[J]. Chinese Journal of General Practice, 2023, 21(6): 932-935, 944. doi: 10.16766/j.cnki.issn.1674-4152.003018
[15]	BICCIRÉ F G, PASTORI D, TANZILLI A, et al. Low serum albumin levels and in-hospital outcomes in patients with ST segment elevation myocardial infarction[J]. Nutr Metab Cardiovasc Dis, 2021, 31(10): 2904-2911.
[16]	ZOANNI B, BRIOSCHI M, MALLIA A, et al. Novel insights about albumin in cardiovascular diseases: focus on heart failure[J]. Mass Spectrom Rev, 2023, 42(4): 1113-1128.
[17]	YALCINKAYA D, KARACALI K, ILHAN B C, et al. Relation between serum uric acid to albumin ratio and severity of chronic coronary artery disease[J]. Angiology, 2023: 33197231161902. DOI: 10.1177/00033197231161902.
[18]	SULTANA S, K M S, PRAKASH V R, et al. Evaluation of uric acid to albumin ratio as a marker of coronary artery disease severity in acute coronary syndrome: a cross-sectional study[J]. Cureus, 2023, 15(11): e49454. DOI: 10.7759/cureus.49454.
[19]	ŞAYLIK F, ÇINAR T, SARIKAYA R, et al. The association of serum uric acid/albumin ratio with the development of coronary collateral circulation in patients with chronic total occluded coronary arteries[J]. J Cardiovasc Thorac Res, 2023, 15(1): 14-21.
[20]	TOPRAK K, YILMAZ R, KAPLANGORAY M, et al. Comparison of the effect of uric acid/albumin ratio on coronary colleteral circulation with other inflammation-based markers in stable coronary artery disease patients[J]. Perfusion, 2023: 2676591231202105. DOI: 10.1177/02676591231202105.
[21]	KALKAN S, CAGAN EFE S, KARAGÖZ A, et al. A new predictor of mortality in ST-elevation myocardial infarction: the uric acid albumin ratio[J]. Angiology, 2022, 73(5): 461-469.