高尿酸血症对颅内动脉粥样硬化的影响
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摘要
目的:分析并探讨高尿酸血症对颅内动脉粥样硬化的影响。方法:选择2014年5月至2016年7月我院收治的250例非心源性脑梗死患者为研究对象,进行数字减影血管造影检查。根据血尿酸(SUA)水平,患者被分为高尿酸血症组(84例)和正常尿酸组(166例),比较两组患者的年龄,高血压、冠心病、糖尿病、高脂血症比例,吸烟史和脑梗死复发率,并采用单因素及多因素回归分析动脉粥样硬化性颅内动脉狭窄的影响因素。结果:与正常尿酸组相比,高尿酸血症组的缺血性脑卒中复发率(25.30%比45.24%,P=0.001)显著增高。单因素分析显示,高血压、糖尿病和高尿酸血症是颅内动脉狭窄发生的影响因素(P均=0.001);多因素回归分析显示,高血压、糖尿病、高尿酸血症是动脉粥样硬化性颅内动脉狭窄的独立危险因素(OR=0.960～4.957,P均=0.001)。结论:高尿酸血症是颅内动脉粥样硬化性狭窄的独立危险因素。临床上应加强对高尿酸血症患者的监测以预防颅内动脉粥样硬化。
Objective: To analyze and explore influence of hyperuricemia(HUA) on intracranial atherosclerosis. Methods:A total of 250 patients with non-cardiogenic cerebral infarction treated in our hospital from May 2014 to Jul 2016 were enrolled.Digital subtraction angiogrophy was performed in all patients. According to level of serum uric acid(SUA), patients were divided into HUA group(n=84) and normal UA group(n=166). Age, percentages of hypertension, coronary heart disease, diabetes mellitus(DM),hyperlipodemia, smoking history and recurrence rate of cerebral infarction were compared between two groups, and influencing factors of atherosclerotic intracranial artery stenosis were analyzed using single-and multi-factor regression analysis. Results:Compared with normal UA group, there was significant rise in recurrence rate of ischemic stroke(25.30% vs. 45.24%) in HUA group, P=0.001. Single factor analysis indicated that hypertension, DM and HUA were influencing factors for intracranial artery stenosis, P=0.001 all; multi-factor regression analysis indicated that hypertension, DM and HUA were independent risk factors for atherosclerotic intracranial artery stenosis(OR=0.960～4.957, P=0.001 all). Conclusion:Hyperuricemia is an independent risk factor for intracranial atherosclerotic stenosis. Monitor on HUA patients should be enhanced in clinic in order to prevent intracranial atherosclerosis.
Objective: To analyze and explore influence of hyperuricemia(HUA) on intracranial atherosclerosis. Methods:A total of 250 patients with non-cardiogenic cerebral infarction treated in our hospital from May 2014 to Jul 2016 were enrolled.Digital subtraction angiogrophy was performed in all patients. According to level of serum uric acid(SUA), patients were divided into HUA group(n=84) and normal UA group(n=166). Age, percentages of hypertension, coronary heart disease, diabetes mellitus(DM),hyperlipodemia, smoking history and recurrence rate of cerebral infarction were compared between two groups, and influencing factors of atherosclerotic intracranial artery stenosis were analyzed using single-and multi-factor regression analysis. Results:Compared with normal UA group, there was significant rise in recurrence rate of ischemic stroke(25.30% vs. 45.24%) in HUA group, P=0.001. Single factor analysis indicated that hypertension, DM and HUA were influencing factors for intracranial artery stenosis, P=0.001 all; multi-factor regression analysis indicated that hypertension, DM and HUA were independent risk factors for atherosclerotic intracranial artery stenosis(OR=0.960～4.957, P=0.001 all). Conclusion:Hyperuricemia is an independent risk factor for intracranial atherosclerotic stenosis. Monitor on HUA patients should be enhanced in clinic in order to prevent intracranial atherosclerosis.
引文
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[13]宋长城,张婷,苏伟,等.高龄老年男性高尿酸血症与下肢动脉硬化的相关性研究[J].中国临床研究,2013,26(5):426-429.
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[18]丁丹丹,王伟,崔中光,等.原发性高尿酸血症患者血小板α-颗粒膜蛋白、血小板活化因子及血小板参数的变化[J].中国实验血液学杂志,2012,20(2):394-397.
[19]赵霞,姬秋和,汤朝武.不同浓度尿酸对体外培养人脐静脉血管内皮细胞增殖过程的影响 [J].中国组织工程研究与临床康复,2007,11(6):1189-1191.
[20]Kawamoto R,Tomita H,Oka Y,et al.Association between uric acid and carotid atherosclerosis in elderly persons[J].Intern Med,2005,44(8):787-793.
[21]赵菁,张志明.高尿酸血症与颈动脉粥样硬化及脑梗死关系的研究[J].吉林医学,2017,38(3):468-470.
[22]Zalawadiya SK,Veeranna V,Mallikethi-Reddy S,et al.Uric acid and cardiovascular disease risk reclassification:findings from NHANES III[J].Eur J Prev Cardiol,2015,22(4):513-518.
[2]Higashida RT,Meyers PM,Connors JJ,et al.Intracranial angioplasty & stenting for cerebral atherosclerosis:a position statement of the Am Society of Int and Therapeutic Neuroradiology,Society of Int Radiol,and the Am Society of Neuroradiology[J].J Vasc Intev Int Radiol,2005,16(10):1281-1285.
[3]吴凤英,胡静.脑梗死与颈动脉粥样硬化斑块及其相关因素分析[J].中国实用神经疾病杂志,2010,13(1):26-28.
[4]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5]刘鹏,刘亚杰,贺雄军,等.不同脑血管狭窄程度患者外周血中树突状细胞数量变化的研究[J].中华神经医学杂志,2012,11(5):476-480.
[6]陈鲲鹏,王俊杰,王利军,等.颈动脉迂曲与颈动脉粥样硬化性狭窄的相关性研究[J].中华外科杂志,2017,55(8):608-612.
[7]Tegos TJ,Kalodiki E,Daskalopoulou SS,et al.Stroke:epidemiology,clinical picture,and risk factors-Part I of III[J].Angiol,2000,51(10):793-808.
[8]张素平,吴文法,范红星,等.高尿酸血症与颅内动脉粥样硬化性狭窄相关性研究[J].中国实用内科杂志,2013(2):138-141.
[9]Hong KS,Bang OY,Kang DW,et al.Stroke Statistics in Korea:Part I.Epidemiology and Risk Factors:A Report from the Korean Stroke Society and Clinical Research Center for Stroke[J].J Stroke,2013,15(1):2-20.
[10]蒋娟莉.高尿酸血症对缺血性脑卒中的影响[J].心血管康复医学杂志,2017,26(6)602-606:.
[11]杨呈伟.高尿酸血症与颈动脉粥样硬化相关性研究进展[J].医学综述,2013,19(2):200-203.
[12]Doehner W,Schoene N,Rauchhaus M,et al.Effects of Xanthine Oxidase Inhibition With Allopurinol on Endothelial Function and Peripheral Blood Flow in Hyperuricemic Patients With Chronic Heart Failure[J].Circulation,2002,105(22):2619-2624.
[13]宋长城,张婷,苏伟,等.高龄老年男性高尿酸血症与下肢动脉硬化的相关性研究[J].中国临床研究,2013,26(5):426-429.
[14]Kim SY,Guevara JP,Kim KM,et al.Hyperuricemia and Risk of Stroke:A Systematic Review and Meta-analysis[J].Arthritis Rheum,2009,61(7):885-892.
[15]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.
[16]Abuja PM.Ascorbate prevents prooxidant effects of urate in oxidation of human low density lipoprotein[J].Febs Let,1999,446(2-3):305-308.
[17]张美琳,黄国伟,常红,等.健康体检人群高尿酸血症及代谢综合征患病分析[J].中国公共卫生,2010,26(3):325-327.
[18]丁丹丹,王伟,崔中光,等.原发性高尿酸血症患者血小板α-颗粒膜蛋白、血小板活化因子及血小板参数的变化[J].中国实验血液学杂志,2012,20(2):394-397.
[19]赵霞,姬秋和,汤朝武.不同浓度尿酸对体外培养人脐静脉血管内皮细胞增殖过程的影响 [J].中国组织工程研究与临床康复,2007,11(6):1189-1191.
[20]Kawamoto R,Tomita H,Oka Y,et al.Association between uric acid and carotid atherosclerosis in elderly persons[J].Intern Med,2005,44(8):787-793.
[21]赵菁,张志明.高尿酸血症与颈动脉粥样硬化及脑梗死关系的研究[J].吉林医学,2017,38(3):468-470.
[22]Zalawadiya SK,Veeranna V,Mallikethi-Reddy S,et al.Uric acid and cardiovascular disease risk reclassification:findings from NHANES III[J].Eur J Prev Cardiol,2015,22(4):513-518.