入院时尿酸水平和急性缺血性脑卒中出院结局不良的关系

摘要

Objective To investigate the relationship between serum urate on admission and the outcome at discharge in patients with acute ischemic stroke . Methods A non‐concurrent cohort study was performed ,a total of 3334 patients who had first or recurrent acute ischemic stroke were continuously included in this study from June 1 ,2009 to May 31 ,2013 ,of whom the demographic characteristics and laboratory data were collected . Poor outcome was defined as the modified Rankin scale (MRs) score equal or exceeding 3 at discharge .We analyzed the baseline variables between good outcome group and poor outcome group .According to the quintile range of serum urate ,patients were divided into five groups ( ≤ 212 μmol/L ,212‐255 μmol/L ,255‐297 μmol/L ,297‐351 μmol/L ,and > 351 μmol/L ) . Logistic regression analysis was used . Results Serum urate on admission was lower in patients with poor outcome than in those with good outcome (P < 0.05) .After serum urate quintiles , the proportion of poor outcome patients in each group were 35.22% , 30.95% , 28.55% , 23.85% ,and 30.03% respectively (P < 0.05 ) .After adjustment for multivariate ,compared with the fourth group ,the OR (95% CI) of first ,second ,third ,and fifth group were 1.658 (1.185‐2.319) ,1.430 (1.024‐1.999) ,1.638 (1.181‐2.272) ,and 1.474 (1.050‐2.069) ,respectively (P < 0.05) .Conclusions A U‐shaped relationship between serum urate quintiles and poor outcome was demonstrated .Lower or higher serum urate may both be harmful to stroke short‐term outcome .%目的：探讨入院时尿酸水平与急性缺血性脑卒中患者出院结局不良的关系。方法采用回顾性队列研究的方法，连续性纳入2009‐06‐01－2013‐05‐31作者医院神经内科住院的急性缺血性脑卒中患者3334例，收集人口统计学和实验室检验资料。结局不良组定义为患者出院时改良 Rankin 量表评分（modified Rankin scale ，MRs）≥3分，对结局不良组和结局良好组患者间基线资料进行比较。用五分位数法将入院时尿酸水平分为5组，分别为≤212μmol／L ，212～255μmol／L ，255～297μmol／L ，297～351μmol／L ，＞351μmol／L 组。用非条件 Logistic 回归分析入院时尿酸水平与急性缺血性脑卒中出院结局不良的关系。结果结局不良组的尿酸水平低于结局良好组（P＜0.05）。对入院时尿酸水平五分位数法分组后，第1～5组的结局不良发生率分别为35.22％、30.95％、28.55％、23.85％和30.03％，各组之间的结局不良发生率比较差异有统计学意义（ P ＝0.0002）。经多因素调整后，以尿酸水平第4分位数组（297～351μmol／L 组）为参比组，第1、2、3、5分位数组相对于参比组的 OR（95％ CI）值分别为1.658（1.185～2.319）、1.430（1.024～1.999）、1.638（1.181～2.272）、1.474（1.050～2.069），均 P＜0.05。结论急性缺血性脑卒中患者入院时尿酸水平和出院结局不良发生率之间呈现近 U 型关系，尿酸水平较低或者较高可能均不利于急性缺血性脑卒中的预后。