目的 探讨血清尿酸(serum uric acid,SUA)与急性缺血性卒中(acute ischemic stroke,AIS)患者发病后1年时转归的相关性.方法 回顾性纳入天津市滨海新区大港医院神经内科收治的AIS患者.根据发病后1年时改良Rankin量表(modified Rankin Scale,mRS)评分将患者分为转归良好组(0～2分)和转归不良组(＞2分),根据发病后1年时生存情况将患者分为生存组和死亡组.比较患者临床基线资料和实验室检查,应用多变量logistic回归分析确定SUA与AIS患者转归不良和死亡的独立相关性.结果 共纳入651例患者,男性430例(66.1％),年龄(67.5±11.7)岁.转归良好组414例(63.6％),转归不良组237例(36.4％);生存组568例(87.3％),死亡组43例(16.7％).单变量分析显示,转归不良组年龄、心房颤动、既往卒中或短暂性脑缺血发作史、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分和入院前mRS评分与转归良好组存在差异,转归不良组高半胱氨酸、SUA、白细胞计数和肌酐高于转归良好组,而红细胞计数和血红蛋白低于转归良好组(P均＜0.05);生存组年龄、缺血性心脏病、心房颤动、既往卒中或短暂性脑缺血发作史、基线NIHSS评分、入院前mRS评分和卒中病因学分型与死亡组存在差异,生存组血红蛋白和甘油三酯高于死亡组,而白细胞计数和肌酐低于死亡组(P均＜0.05).多变量logistic回归分析显示,SUA是AIS患者转归不良的独立危险因素(优势比1.004,95％置信区间1.001～1.006;P＜0.01),但与死亡转归无独立相关性.结论 较高的SUA是AIS患者发病后1年时转归不良的独立危险因素.
Association of serum uric acid with outcome at one year in patients with acute ischemic stroke
Objective To investigate the association of serum uric acid(SUA)with the outcome in patients with acute ischemic stroke(AIS)at one year after onset.Methods Patients with AIS admitted to the Department of Neurology,Dagang Hospital,Tianjin Binhai New Area were included retrospectively.According to the modified Rankin Scale(mRS)score at 1 year after onset,patients were divided into a good outcome group(0-2)and a poor outcome group(＞2).They were also divided into a survival group and a death group based on their survival status at 1 year after onset.The clinical baseline data and laboratory tests were compared.Multivariate logistic regression analysis was used to determine the associations of SUA with poor outcome and death in patients with AIS.Results A total of 651 patients were enrolled,including 430 males(66.1％)aged 67.5±11.7 years.Four hundred and fourteen patients(63.6％)were in the good outcome group,and 237(36.4％)were in the poor outcome group.There were 568 patients(87.3％)in the survival group and 43(16.7％)in the death group.Univariate analysis showed that there were differences in age,atrial fibrillation,history of stroke or transient ischemic attack,baseline National Institutes of Health Stroke Scale(NIHSS)score,and pre-admission mRS score between the poor outcome group and the good outcome group.The homocysteine,SUA,white blood cell count,and creatinine in the poor outcome group were higher than those in the good outcome group,while the red blood cell count and hemoglobin were lower than those in the good outcome group(all P＜0.05).There were differences in age,history of ischemic heart disease,atrial fibrillation,history of stroke or transient ischemic attack,baseline NIHSS score,pre-admission mRS score,and stroke etiology classification between the survival group and the death group.Hemoglobin and triglycerides in the survival group were higher than those in the death group,while the white blood cell count and creatinine were lower than those in the death group(all P＜0.05).Multivariate logistic regression analysis showed that SUA was an independent risk factor for poor outcome in patients with AIS(odds ratio 1.004,95％confidence interval 1.001-1.006;P＜0.01),but there was no independent correlation with death.Conclusion Higher SUA is an independent risk factor for poor outcome at one year after onset in patients with AIS.
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