血尿酸水平与急性缺血性卒中病情严重程度和预后的关系研究

doi:10.3969/j.issn.1673-5765.2019.03.003

摘要/Abstract

摘要：

目的探讨急性缺血性卒中患者血清UA水平与病情严重程度及预后的关系。方法回顾性收集在深圳市第二人民医院神经内科2014年1月-2017年12月住院的急性缺血性卒中患者。根据血UA水平进行三分位数分组：低分位数组（3.85～298.80）μmol/L、中分位数组（299.80～398.00）μmol/L和高分位数组（402.30～702.10）μmol/L。多因素回归分析急性缺血性卒中患者中病情严重程度及临床预后的危险因素，分层分析不同人群UA水平与病情严重程度及临床预后的关系。结果 227例入组患者中，UA低分位数组75例、中分位数组72例，高分位数组80例。调整混杂因素后，相比低分位数组，UA高分位数组患者入院NIHSS评分下降2.16分（β=-2.16，95%CI -3.53～-0.78， P =0.002），发生早期神经功能恶化（early neurological deterioration，END）的风险下降60%（OR 0.40， 95%CI 0.16～0.97，P =0.042）。分层分析发现，在男性和既往无卒中史的患者中，随着UA水平升高，入院NIHSS评分降低，END减少，差异具有统计学意义。结论高UA水平是急性缺血性卒中严重程度的保护因素，能降低END；其对男性和新发急性缺血性卒中患者的保护性更明显。

文章导读： 本研究对目前与卒中关系存在争议的UA进行了多因素分析，提示高UA水平是急性缺血性卒中严重程度的独立保护因素，能降低患者的短期神经功能恶化。

关键词: 缺血性卒中; 尿酸; 神经功能缺损; 氧化应激; 预后

Abstract:

Objective To investigate the relationship between serum UA level and stroke severity and prognosis of acute ischemic stroke (AIS). Methods Data of consecutive AIS patients from Shenzhen Second People's Hospital during January 2014 to December 2017 were retrospectively collected. According to UA tertile levels, all patients were divided into three groups: low-level group (3.85-298.80) μmol/L, moderate-level group (299.80-398.00) μmol/L and high-level group (402.30-702.10) μmol/L. Multivariate regression analysis was used to analyze the risk factors of stroke severity and prognosis in AIS patients. Stratified analysis was used to analyze the relationship between serum UA levels and stroke severity and clinical prognosis in different risk stratification subgroups. Results Among the total 227 patients, 75 cases in low-level group, 72 cases in moderate-level group and 80 cases in high-level group. After adjusting the confounding factors, comparing with the lowlevel group, the NIHSS score at admission decreased by 2.16 points (β -2.16, 95%CI -3.53- -0.78,P =0.002) and the rate of early neurological deterioration (END) decreased by 60% (OR 0.40, 95%CI 0.16-0.97, P =0.042) in the high-level group. Stratified analysis result showed that with the increase of serum UA level, the NIHSS score at admission (stroke severity) decreased and the short-term clinical prognosis were better in male and newly diagnosed stroke patients. Conclusions The serum UA level was associated with stroke severity and END in AIS patients, especially in male and newly diagnosed stroke patients.

Key words: Ischemic stroke; Uric acid; Neurological deficit; Oxidative stress; Prognosis

汪云云，谢小华，任力杰，杨梅，潘璐，鄢凤仙，张剑，邓丽萍，熊小云. 血尿酸水平与急性缺血性卒中病情严重程度和预后的关系研究[J]. 中国卒中杂志, 2019, 14(03): 207-212.

WANG Yun-Yun, XIE Xiao-Hua, REN Li-Jie, YANG-Mei, PAN Lu, YAN Feng-Xian, ZHANG Jian, DENG Li-Ping,XIONG Xiao-Yun. Association of Serum Uric Acid Level with Stroke Severity and Prognosis in Patients with Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2019, 14(03): 207-212.

参考文献

[1] WANG Y，LIU M，PU C. 2014 Chinese guidelines

for secondary prevention of ischemic stroke and

transient ischemic attack[J]. Int J Stroke，2017，

12（3）：302-320.

[2] FEIGIN V L，FOROUZANFAR M H，

KRISHNAMURTHI R，et al. Global and regional

burden of stroke during 1990-2010：findings from

the Global Burden of Disease Study 2010[J]. Lancet，

2014，383（9913）：245-254.

[3] KAMEI K，KONTA T，HIRAYAMA A，et al.

Associations between serum uric acid levels and

the incidence of nonfatal stroke：a nationwide

community-based cohort study[J]. Clin Exp Nephrol，

2017，21（3）：497-503.

[4] FABBRINI E，SERAFINI M，COLIC B I，et al.

Effect of plasma uric acid on antioxidant capacity，

oxidative stress，and insulin sensitivity in obese

subjects[J]. Diabetes，2014，63（3）：976-981.

[5] MAPOURE Y N，AYEAH C M，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.

[6] YANG Y，ZHANG Y，LI Y，et al. U-Shaped

relationship between functional outcome and serum

uric acid in ischemic stroke[J]. Cell Physiol Biochem，

2018，47（6）：2369-2379.

[7] WANG Y，LI J，SUN X，et al. High serum uric acid

levels are a protective factor against unfavourable

neurological functional outcome in patients with

ischaemic stroke[J]. J Int Med Res，2018，46（5）：

1826-1838.

[8] 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/OL]. BMC Neurology，2017，

17（1）：21. doi：10.1186/s12883-017-0793-6.https：//

bmcneurol.biomedcentral.com/articles/10.1186/

s12883-017-0793-6.

[9] LLULL L，LAREDO C，RENU A，et al. Uric acid

therapy improves clinical outcome in women with

acute ischemic stroke[J]. Stroke，2015，46（8）：

2162-2167.

[10] SIEGLER J E，BOEHME A K，KUMAR A D，et

al. What change in the National Institutes of Health

Stroke Scale should define neurologic deterioration

in acute ischemic stroke?[J]. J Stroke Cerebrovasc

Dis，2013，22（5）：675-682.

[11] HUANG Y C，TSAI Y H，LEE J D，et al. A novel

neuroimaging model to predict early neurological deterioration after acute ischemic stroke[J]. Curr

Neurovasc Res，2018，15（2）：129-137.

[12] HIGGINS P，FERGUSON L D，WALTERS M

R. Xanthine oxidase inhibition for the treatment

of stroke disease：a novel therapeutic approach[J].

Expert Rev Cardiovasc Ther，2011，9（4）：399-401.

[13] LIU H，REYNOLDS G P，WANG W，et al. Lower

uric acid is associated with poor short-term

outcome and a higher frequency of posterior arterial

involvement in ischemic stroke[J]. Neurol Sci，2018，

39（6）：1117-1119.

[14] SUN M S，JIN H，SUN X，et al. Free radical

damage in ischemia-reperfusion injury：an obstacle

in acute ischemic stroke after revascularization

therapy[J/OL]. Oxid Med Cell Longev，2018，2018：

3804979. https：//doi.org/10.1155/2018/3804979.

[15] CUTLER R G，CAMANDOLA S，FELDMAN N

H，et al. Uric acid enhances longevity and endurance

and protects the brain against ischemia[J/OL].

Neurobiol Aging，2019，75：159-168. https：//doi.

org/10.1016/j.neurobiolaging.2018.10.031.

[16] 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.

[17] SHI X，YANG J，WANG L，et al. Prospective study

of serum uric acid levels and stroke in a Chinese

hypertensive cohort[J]. Clin Exp Hypertens，2017，

39（6）：527-531.

[18] WANG P，LI X，HE C，et al. Hyperuricemia and

prognosis of acute ischemic stroke in diabetic

patients[J]. Neurol Res，2019，41（3）：250-256.

[19] AHOLA A J，SANDHOLM N，FORSBLOM C，et

al. The serum uric acid concentration is not causally

linked to diabetic nephropathy in type 1 diabetes[J].

Kidney Int，2017，91（5）：1178-1185.