尿酸与急性缺血性脑卒中早期预后关系的研究
|
摘要
目的探讨血清尿酸与急性缺血性脑卒中早期预后的关系。方法选择2015年3月～2016年3月西安交通大学第一附属医院神经内科连续住院治疗的急性缺血性脑卒中患者421例,根据出院时预后情况分为预后良好组232例[改良的Rankin评分(modified Rankin scale,mRS)0～2分],预后不良组189例(mRS 3～6分)。采集整理患者入院时人口学信息、血管相关危险因素、尿酸等实验室指标、影像学资料及疾病相关临床指标,包括美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分。对2组患者上述临床特点进行比较,并通过非条件logistic回归分析尿酸与急性缺血性脑卒中早期预后的关系。结果预后不良组心房颤动、收缩压、TC、LDL、尿素、NIHSS评分、脑梗死位于大脑前动脉及大脑中动脉、住院时间、死亡和出院mRS评分明显高于预后良好组,尿酸和格拉斯哥昏迷评分明显低于预后良好组,差异有统计学意义(P<0.05,P<0.01)。非条件logistic回归分析显示,收缩压、NIHSS评分和尿酸为急性缺血性脑卒中患者预后不良的主要因素(OR=1.017,95%CI:1.003～1.031,P=0.018;OR=1.274,95%CI:1.178～1.378,P=0.000;OR=0.993,95%CI:0.989～0.996,P=0.000)。结论血清低尿酸可能与急性缺血性脑卒中早期预后不良相关。
Objective To study the relationship between serum UA level and early outcome in acute ischemic stroke(AIS)patients.Methods Four hundred and twenty-one AIS patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University from March 2015 to March 2016 were divided into good outcome group(n=232)and poor outcome group(n=189)according to their modified Rankin scale(mRS)score.Their demographic data,risk factors for vascular disease,laboratory testing parameters,imaging and clinical data and NIHSS score were recorded and compared.The relationship between serum UA level and early poor outcome in AIS patients was analyzed by unconditioned logistic regression analysis.Results The incidence of AF and cerebral infarction in the territory of anterior cerebral artey and middle cerebral artery,SBP,serum TC,LDL and urea levels,NIHSS and mRS score,and mortality were significantly higher and the hospital stay time was significantly longer while the serum UA level and GCS score were significantly lower in poor outcome group than in good outcome group(P<0.05,P<0.01).Unconditioned logistic regression analysis showed that SBP,NIHSS score and serum UA level were the major risk factors for the early poor outcome in AIS patients(OR=1.017,95%CI:1.003-1.031,P=0.018;OR=1.274,95%CI:1.178-1.378,P =0.000;OR =0.993,95%CI:0.989-0.996,P =0.000).Conclusion The low serum UA level is related with the early poor outcome in AIS patients.
Objective To study the relationship between serum UA level and early outcome in acute ischemic stroke(AIS)patients.Methods Four hundred and twenty-one AIS patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University from March 2015 to March 2016 were divided into good outcome group(n=232)and poor outcome group(n=189)according to their modified Rankin scale(mRS)score.Their demographic data,risk factors for vascular disease,laboratory testing parameters,imaging and clinical data and NIHSS score were recorded and compared.The relationship between serum UA level and early poor outcome in AIS patients was analyzed by unconditioned logistic regression analysis.Results The incidence of AF and cerebral infarction in the territory of anterior cerebral artey and middle cerebral artery,SBP,serum TC,LDL and urea levels,NIHSS and mRS score,and mortality were significantly higher and the hospital stay time was significantly longer while the serum UA level and GCS score were significantly lower in poor outcome group than in good outcome group(P<0.05,P<0.01).Unconditioned logistic regression analysis showed that SBP,NIHSS score and serum UA level were the major risk factors for the early poor outcome in AIS patients(OR=1.017,95%CI:1.003-1.031,P=0.018;OR=1.274,95%CI:1.178-1.378,P =0.000;OR =0.993,95%CI:0.989-0.996,P =0.000).Conclusion The low serum UA level is related with the early poor outcome in AIS patients.
引文
[1]Zhao WJ,An Z,Hong Y,et al.Low total cholesterol level is the independent predictor of poor outcomes in patients with acute ischemic stroke:a hospital-based prospective study[J].BMC Neurol,2016,16:36.DOI:10.1186/s12883-016-0561-z.
[2]Chamorro,Dirnagl U,Urra X,et al.Neuroprotection in acute stroke:targeting excitotoxicity,oxidative and nitrosative stress,and inflammation[J].Lancet Neurol,2016,15(8):869-881.DOI:10.1016/S1474-4422(16)00114-9.
[3]Wu H,Jia Q,Liu G,et al.Decreased uric acid levels correlate with poor outcomes in acute ischemic stroke patients,but not in cerebral hemorrhage patients[J].J Stroke Cerebrovasc Dis,2014,23(3):469-475.DOI:10.1016/j.jstrokecerebrovasdis.2013.04.007.
[4]Wu S,Pan Y,Zhang N,et al.Lower serum uric acid level strongly predict short-term poor functional outcome in acute stroke with normoglycaemia:a cohort study in China[J].BMCNeurol,2017,17(1):21.DOI:10.1186/s12883-017-0793-6.
[5]Mapoure YN,Ayeah CM,Ba H,et al.The prognostic value of serum uric acid in the acute phase of ischemic stroke in black africans[J].J Stroke Cerebrovasc Dis,2018,27(3):783-792.DOI:10.1016/j.jstrokecerebrovasdis.2017.10.006.
[6]Falsetti L,Capeci W,Tarquinio N,et al.Serum uric acid,kidney function and acute ischemic stroke outcomes in elderly patients:a single-cohort,perspective study[J].Neurol Int,2017,9(1):6920.DOI:10.4081/ni.2017.6920.
[7]Naganuma M,Inatomi Y,Nakajima M,et al.Associations between uric acid level and 3-month functional outcome in acute ischemic stroke patients treated with/without edaravone[J].Cerebrovasc Dis,2018,45(3-4):115-123.DOI:10.1159/000488038.
[8]Wang Z,Lin Y,Liu Y,et al.Serum uric acid levels and outcomes after acute ischemic stroke[J].Mol Neurobiol,2016,53(3):1753-1759.DOI:10.1007/s12035-015-9134-1.
[9]Justicia C,Salas-Perdomo A,Pérez-de-Puig I,et al.Uric acid is protective after cerebral ischemia/reperfusion in hyperglycemic mice[J].Transl Stroke Res,2017,8(3):294-305.DOI:10.1007/s12975-016-0515-1.
[10]Dhanesha N,Vázquez-Rosa E,Cintrón-Pérez CJ,et al.Treatment with uric acid reduces infarct and improves neurologic function in female mice after transient cerebral ischemia[J].Jstroke cerebrovasc dis,2018,27(5):1412-1416.DOI:10.1016/j.jstrokecerebrovasdis.2017.12.043.
[11]Li M,Hu X,Fan Y,et al.Hyperuricemia and the risk for coronary heart disease morbidity and mortality a systematic review and dose-response meta-analysis[J].Sci Rep,2016,6:19520.DOI:10.1038/srep19520.
[12]Iida S,Yamamoto Y,Susa C,et al.5-N-carboxyimino-6-N-chloroaminopyrimidine-2,4(3H)-dione as a hypochlorite-specific oxidation product of uric acid[J].J Clin Biochem Nutr,2018,63(2):85-89.DOI:10.3164/jcbn.18-6.
[13]Liu H,He J,Zhong J,et al.Clinical and basic evaluation of the prognostic value of uric acid in traumatic brain injury[J].Int JMed Sci,2018,15(10):1072-1082.DOI:10.7150/ijms.25799.
[14]Dimitroula HV,Hatzitolios AI,Karvounis HI.The role of uric acid in stroke:the issue remains unresolved[J].Neurologist,2008,14(4):238-242.DOI:10.1097/NRL.0b013e31815c666b.
[15]Ben Salem C,Slim R,Fathallah N,et al.Drug-induced hyperuricaemia and gout[J].Rheumatology(Oxford),2017,56(5):679-688.DOI:10.1093/rheumatology/kew293.
[2]Chamorro,Dirnagl U,Urra X,et al.Neuroprotection in acute stroke:targeting excitotoxicity,oxidative and nitrosative stress,and inflammation[J].Lancet Neurol,2016,15(8):869-881.DOI:10.1016/S1474-4422(16)00114-9.
[3]Wu H,Jia Q,Liu G,et al.Decreased uric acid levels correlate with poor outcomes in acute ischemic stroke patients,but not in cerebral hemorrhage patients[J].J Stroke Cerebrovasc Dis,2014,23(3):469-475.DOI:10.1016/j.jstrokecerebrovasdis.2013.04.007.
[4]Wu S,Pan Y,Zhang N,et al.Lower serum uric acid level strongly predict short-term poor functional outcome in acute stroke with normoglycaemia:a cohort study in China[J].BMCNeurol,2017,17(1):21.DOI:10.1186/s12883-017-0793-6.
[5]Mapoure YN,Ayeah CM,Ba H,et al.The prognostic value of serum uric acid in the acute phase of ischemic stroke in black africans[J].J Stroke Cerebrovasc Dis,2018,27(3):783-792.DOI:10.1016/j.jstrokecerebrovasdis.2017.10.006.
[6]Falsetti L,Capeci W,Tarquinio N,et al.Serum uric acid,kidney function and acute ischemic stroke outcomes in elderly patients:a single-cohort,perspective study[J].Neurol Int,2017,9(1):6920.DOI:10.4081/ni.2017.6920.
[7]Naganuma M,Inatomi Y,Nakajima M,et al.Associations between uric acid level and 3-month functional outcome in acute ischemic stroke patients treated with/without edaravone[J].Cerebrovasc Dis,2018,45(3-4):115-123.DOI:10.1159/000488038.
[8]Wang Z,Lin Y,Liu Y,et al.Serum uric acid levels and outcomes after acute ischemic stroke[J].Mol Neurobiol,2016,53(3):1753-1759.DOI:10.1007/s12035-015-9134-1.
[9]Justicia C,Salas-Perdomo A,Pérez-de-Puig I,et al.Uric acid is protective after cerebral ischemia/reperfusion in hyperglycemic mice[J].Transl Stroke Res,2017,8(3):294-305.DOI:10.1007/s12975-016-0515-1.
[10]Dhanesha N,Vázquez-Rosa E,Cintrón-Pérez CJ,et al.Treatment with uric acid reduces infarct and improves neurologic function in female mice after transient cerebral ischemia[J].Jstroke cerebrovasc dis,2018,27(5):1412-1416.DOI:10.1016/j.jstrokecerebrovasdis.2017.12.043.
[11]Li M,Hu X,Fan Y,et al.Hyperuricemia and the risk for coronary heart disease morbidity and mortality a systematic review and dose-response meta-analysis[J].Sci Rep,2016,6:19520.DOI:10.1038/srep19520.
[12]Iida S,Yamamoto Y,Susa C,et al.5-N-carboxyimino-6-N-chloroaminopyrimidine-2,4(3H)-dione as a hypochlorite-specific oxidation product of uric acid[J].J Clin Biochem Nutr,2018,63(2):85-89.DOI:10.3164/jcbn.18-6.
[13]Liu H,He J,Zhong J,et al.Clinical and basic evaluation of the prognostic value of uric acid in traumatic brain injury[J].Int JMed Sci,2018,15(10):1072-1082.DOI:10.7150/ijms.25799.
[14]Dimitroula HV,Hatzitolios AI,Karvounis HI.The role of uric acid in stroke:the issue remains unresolved[J].Neurologist,2008,14(4):238-242.DOI:10.1097/NRL.0b013e31815c666b.
[15]Ben Salem C,Slim R,Fathallah N,et al.Drug-induced hyperuricaemia and gout[J].Rheumatology(Oxford),2017,56(5):679-688.DOI:10.1093/rheumatology/kew293.