摘要
目的探讨原发性高血压(HP)患者血尿酸水平与升主动脉内径的关系。方法回顾性分析2013年4月至2014年4月首都医科大学附属北京安贞医院高血压科住院的275例HP患者的临床资料,均行超声心动图,根据升主动脉内径将入选患者分为观察组(升主动脉内径增宽,≥35 mm,130例)和对照组(升主动脉内径正常,<35 mm,145例)。收集患者的相关临床资料、血尿酸指标、24 h动态血压监测结果。通过多元Logistic逐步回归方法分析升主动脉内径的影响因素,受试者工作特征(ROC)曲线分析血尿酸水平对升主动脉内径增宽的诊断作用。结果观察组血尿酸水平明显高于对照组[(373±10)μmol/L比(314±10)μmol/L],差异有统计学意义(P <0. 001)。观察组24 h平均收缩压、白天平均收缩压、夜间平均收缩压、24 h平均舒张压、白天平均舒张压、夜间平均舒张压明显高于对照组,差异均有统计学意义(均P <0. 05)。多元Logistic回归分析结果显示,血尿酸与升主动脉内径明显相关(β=0. 700,P <0. 05)。ROC曲线分析显示,血尿酸临界点为348. 35μmol/L,对升主动脉内径增宽有一定的诊断作用,敏感度59. 2%,特异度61. 0%。结论在HP患者中血尿酸水平与升主动脉内径密切相关,对升主动脉内径增宽的有一定预测作用。
Objective To investigate the correlation between serum uric acid level and ascending aorta diameter in patients with primary hypertension( HP). Methods Clinical data of 275 HP patients admitted to Beijing Anzhen Hospital,Capital Medical University between April 2013 and April 2014 were retrospectively analyzed. According to ascending aorta diameter measured by echocardiography,the patients were divided into observation group( ≥35 mm,130 cases) and control group( < 35 mm,145 cases). Influence factors of ascending aorta diameter were analyzed among the clinical data,serum uric acid level,24 h ambulatory blood pressure monitoring parameters through multivariate logistic stepwise regression. Diagnostic value of serum uric acid level for ascending aorta diameter extension was analyzed through receiver operating characteristics( ROC) curve.Results Serum uric acid level in observation group was significantly higher than that in control group[( 373 ±10) μmol/L vs( 314 ± 10) μmol/L]( P < 0. 001). The 24 h mean systolic pressure,daytime mean systolic pressure,nocturnal mean systolic pressure,24 h mean diastolic pressure,daytime mean diastolic pressure and nocturnal mean diastolic pressure in observation group were significantly higher than those in control group( all P <0. 05). Multivariate logistic stepwise regression showed that serum uric acid level was related with ascending aorta diameter( β = 0. 700,P < 0. 05). ROC curve showed that the critical point of serum uric acid in the diagnosis of ascending aorta diameter extension was 348. 35 μmol/L; the sensitivity was 59. 2% and the specificity was61. 0%. Conclusion There is a clear correlation between serum uric acid level and ascending aorta diameter in HP patients; serum uric acid is a risk factor of ascending aorta diameter extension.
引文
[1]Billiet L,Doaty S,Katz JD,et al. Review of hyperuricemia as new marker for metabolic syndrome[J]. ISRN Rheumatol,2014(2014):852954. DOI:10. 1155/2014/852954.
[2]Patetsios P,Rodino W,Wisselink W,et al. Identification of uric acid in aortic aneurysms and atherescleretic artery[J]. Ann N Y Acad Sci,1996(800):243-245.
[3]Bilen E,Ak?ay M,Bayram NA,et al. Aortic elastic properties and left ventricular diastolic function In patients with isolated bicuspid aortic value[J]. J Heart Valve Dis,2012,21(2):189-194. DOI:10. 1093/eurheartj/ehr480.
[4]von Eckardstein A. Risk factors for atherosclerotic vascular disease[J].Handb Exp Pharmacol,2005(107):1101-1106. DOI:10. 1007/3-540-27661-0_2.
[5]Feig DI, Johnson RJ. Hyperuricemia in childhood primary hypertension[J]. Hypertension,2003,42(3):247-252. DOI:10. 1161/01. HYP. 0000085858. 66548. 59.
[6]Grayson PC,Kim SY,La Valley M,et al. Hypemricemia and incident hypertension:a systematic review and meta-analysis[J].Arthritis Care Res(Hoboken),201l,63(1):102-110. DOI:10.1002/acr. 20344.
[7]Oh J,Won HY,Kang SM. Uric acid and cardiovasculal risk[J].N Engl J Med,2009,360(5):539-540. DOI:10. 1056/NEJMra0800885.
[8]代玉川,李传方,张猛,等.主动脉夹层与高尿酸血症相关性研究[J].实用心脑肺血管病杂志,2012,20(4):592-593. DOI:10. 3969/j. issn. 1008-5971. 2012. 04. 009.Dai YC,Li CF,Zhang M,et al. Aortic dissection associated with hyperuricemia research[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease,2012,20(4):592-593. DOI:10.3969/j. issn. 1008-5971. 2012. 04. 009.
[9]Esen AM,Akcakoyun M,Esen O,et al. Uric acid as a marker of oxidative stress in dilatation of the ascending aorta[J]. Am J Hypertens,2011,24(2):149-154. DOI:10. 1038/ajh. 2010. 219.
[10]Tokita Y,Kusama Y,Kodani E,et al. Utility of rapid D-dimmer measurement for screening of acute cardiovascular disease in the emergency setting[J]. J Cardiol,2009,53(3):334-340. DOI:10. 1016/j. jjcc. 2008. 12. 001.
[11]Suzuki T,Distante A,Zizza A,et al. Diagnosis of acute aortic dissection by D-dimer:the International Registry of Acute Aortic Dissection Substudy on Biomarkers(IRAD-Bio)experience[J].Circulation,2009,119(20):2702-2707. DOI:10. 1161/CIRCULATIONAHA. 108. 833004.
[12]Sautin YY, Johnson RJ. Uric acid:the oxidant-antioxidant paradox[J]. Nucleosides Nucleotides Nucleic Acids,2008,27(6):608-619. DOI:10. 1080/15257770802138558.
[13]Mazzali M,Hushes J,Kim YG,et al. Elevated uric acid increases blood pressure in the rat by a noval crystal independent mechanism[J].Hypertension,2001,38(5):1101-1106. DOI:10. 1161/hy1101.092839.
[14]Ingelsson E,Pencina MJ,Levy D,et al. Aortic root diameter and longitudinal blood pressure tracking[J]. Hypertension,2008,52(3):473-477. DOI:10. 1161/hypertensionaha. 108. 114157.
[15]Ohnaka K,Numaguchi K,Yamakawa T,et al. Induction of cyclooxygenase-2 by angiotensin II in cultured rat vascular smooth muscle cells[J]. Hypentension,2000,35(1 Pt 1):68-75. DOI:10. 1161/01. hyp. 35. 1. 68.
[16]敖道畅,袁润强,庄楚璇.高尿酸血症与泌尿系统结石的关系探讨[J].海南医学,2009,20(6):147,168. DOI:10. 3969/j.issn. 1003-6350. 2009. 06. 068.Ao DC,Yuan RQ,Zhuang CX. Relationship between hyperuricemia and urolithiasis[J]. Hainan Medical Journal,2009,20(6):147,168. DOI:10. 3969/j. issn. 1003-6350. 2009. 06. 068.
