目的探讨急性缺血性卒中患者血尿酸水平与脑白质病变（white matter lesions，WMLs）的相关性。方法连续入选2011年1月～2012年12月发病48 h内的首发缺血性卒中患者进行横断面研究，按照Ylikoski评分将患者分为两组：重度WMLs组、无或轻度WMLs组。比较两组患者血糖、甘油三酯（triglyceride，TG）、总胆固醇（total cholesterol，TC）、低密度脂蛋白-胆固醇（low density lipoprotein-cholesterol，LDL-C）、高密度脂蛋白-胆固醇（high density lipoprotein-cholesterol，HDL-C）及血尿酸水平，并行Logistic回归分析重度WMLs危险因素。 结果共入选急性缺血性卒中患者321例，其中重度WMLs组159例，无或轻度WMLs组162例。重度WMLs组患者年龄（P＜0.001）、糖尿病发生率（P=0.011）、血糖（P＜0.001）、血尿酸水平（P＜0.001）、高尿酸血症发生率（P=0.002）均高于无或轻度WMLs组（P均＜0.05），两组性别、高血压发生率、收缩压、舒张压、心房颤动发生率、血TG、TC、LDL-C、HDL-C水平、吸烟史比例无显著差异。校正年龄、性别、血压、伴发高血压、糖尿病、心房颤动、血糖、血脂及吸烟史后，年龄[比值比（odds ratio， OR）1.062，95%可信区间（confidence interval，CI）1.0008～1.119，P=0.023]、血尿酸水平（OR 1.531，95%CI 1.186～1.975，P=0.001）和高尿酸血症（OR 1.131，95%CI 1.047～1.222，P=0.002）是急性缺血性卒中患者发生重度WMLs的独立危险因素。 结论血尿酸水平和高尿酸血症是急性缺血性卒中患者伴发重度WMLs的独立危险因素。%Objective To investigate the relationship between serum uric acid and white matter lesions (WMLs) in cerebral ischemic stroke patients. Methods From January 2011 to December 2012, a cross-sectional study was conducted at the in-patient Department of Neurology of the First Hospital of Nanchang. All consecutive patients with ifrst-episode cerebral ischemic stroke admitted to hospital within 48 hours of onset were recruited into this study. The patients were divided into severe WML group and mild WML group according to the Ylikoski scores. Serum biochemical indices including serum uric acid, serum glucose, triglyceride (TG), total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C) and high density lipoprotein-cholesterol (HDL-C) were compared between the two groups, and risk factors for severe WMLs were analyzed with multivariate Logistic regression models. Results Three hundred and twenty-one patients with cerebral ischemic stroke were enrolled into this study, 159 of them for severe WML group and 162 for mild WML group. The age (P<0.001), the incidence of diabetes (P=0.011), serum glucose (P<0.001), serum uric acid (P<0.001) and the incidence of hyperuricemia (P=0.002) were higher in severe WMLs group than in mild WMIs group, while the sex, the incidence of hypertension, systolic pressure, diastolic pressure, the incidence of atrial ifbrillation, TG, TC, LDL-C, HDL-C and smoking history between the two groups showed no differences (all P>0.05). Age (odds ratio [OR] 1.062, 95%conifdence interval [CI] 1.0008~1.119,P=0.023), serum uric acid (OR 1.531, 95%CI 1.186~1.975, P=0.001) and hyperuricemia (OR 1.131, 95%CI 1.047~1.222, P=0.002) were independent risk factors for severe WMLs after adjustment for sex, blood pressure, concomitant hypertension, diabetes, atrial ifbrillation, serum glucose, serum lipid and smoking history. Conclusion These data suggest that serum uric acid and hyperuricemia are independent risk factors for severe WMLs in cerebral ischemic stroke patients.
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