中国心血管杂志2024，Vol.29Issue(5) ：419-424.DOI:10.3969/j.issn.1007-5410.2024.05.006

高尿酸血症与高龄老年非瓣膜性心房颤动患者长期预后的相关性分析

Association between hyperuricemia and long-term prognosis in elderly patients with nonvalvular atrial fibrillation

何艳茹 张丽莎 刘小军 王新宏
中国心血管杂志2024，Vol.29Issue(5) ：419-424.DOI:10.3969/j.issn.1007-5410.2024.05.006
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  • 万方数据

高尿酸血症与高龄老年非瓣膜性心房颤动患者长期预后的相关性分析

Association between hyperuricemia and long-term prognosis in elderly patients with nonvalvular atrial fibrillation

何艳茹 1张丽莎 1刘小军 1王新宏1
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作者信息

  • 1. 710004 西安交通大学第二附属医院心血管内科
  • 折叠

摘要

目的 探讨高尿酸血症与 80 岁及以上(高龄)老年非瓣膜性心房颤动(房颤)患者预后的关系.方法 回顾性研究.纳入 2018-2022 年就诊于西安交通大学第二附属医院的高龄老年非瓣膜性房颤患者 268 例,收集患者临床资料.根据血尿酸水平(是否≥420 μmol/L)分为高尿酸血症组(94 例)和血尿酸正常组(174 例),比较两组临床特点,并分析高尿酸血症与高龄老年非瓣膜性房颤患者预后的关系.结果 与血尿酸正常组比较,高尿酸血症组合并冠心病、纽约心脏病协会(NYHA)心功能分级Ⅱ级和持续性房颤比例更高,CHA2 DS2-VASc和HAS-BLED评分更高,N末端B型利钠肽原、血肌酐水平更高,估算的肾小球滤过率、高密度脂蛋白胆固醇水平更低,左心房前后径更大,左心室射血分数更低,差异均有统计学意义(均为P<0.05).中位随访 22(11,36)个月,共失访27 例(10.1%),62 例(23.1%)患者发生复合终点事件,其中高尿酸血症组 30 例(31.9%),血尿酸正常组 32 例(18.4%).Kaplan-Meier生存曲线显示,高尿酸血症组复合终点事件发生率显著高于血尿酸正常组(log-rank P=0.001).单因素Cox回归分析显示,高尿酸血症、血尿酸水平、NYHA心功能分级Ⅱ级、左心室舒张末期前后径和抗凝治疗是复合终点事件发生的影响因素(均为P<0.05).将高尿酸血症与其他多项混杂因素纳入多因素Cox回归分析后显示,高尿酸血症仍是高龄老年非瓣膜性房颤患者远期预后不良的独立预测因素(HR=1.849,95%CI:1.049～3.259,P=0.033).结论 合并高尿酸血症的高龄老年非瓣膜性房颤患者远期预后较差,高尿酸血症是高龄老年非瓣膜性房颤患者预后不良的独立危险因素.

Abstract

Objective To analyze the association between hyperuricemia and prognosis in elderly patients(aged 80 and over)with nonvalvular atrial fibrillation.Methods This was a retrospective study.The clinical characteristics and follow up data of 268 elderly patients with nonvalvular atrial fibrillation between 2018 and 2022 were retrospectively collected.The clinical characteristics between patients with hyperuricemia(serum uric acid≥420 μmol/L,94 cases)and normal uric acid(serum uric acid<420 μmol/L,174 cases)were compared,and the relationship between hyperuricemia and their prognosis were further analyzed.Results Compared with patients with normal uric acid,those with hyperuricemia were more frequently with coronary artery disease,New York Heart Association(NYHA)class Ⅱ,and persistent atrial fibrillation.They also had higher level of CHA2 DS2-VASc score,HAS-BLED score,N-terminal pro-brain natriuretic peptide(NT-proBNP),serum creatinine and left atrial diameters,and lower level of the estimated glomerular filtration rate(eGFR),high-density lipoprotein cholesterol(HDL-C)and left ventricular ejection fraction(LVEF)(all P<0.05).During a median follow up of 22(11,36)months,27 patients(10.1%)were lost follow up.30(31.9%)and 32(18.4%)composite endpoints occurred among patients with hyperuricemia and normal uric acid,respectively.Kaplan-Meier analysis showed that patients with hyperuricemia had a poorer prognosis during follow-up(log-rank P=0.001).In the univariate Cox analyses,hyperuricemia,the serum uric acid level,NYHA class Ⅱ,left ventricular end-diastolic diameter,and anticoagulant therapy were associated with composite endpoints(all P<0.05).After adjusting for multiple confounding factors,hyperuricemia was also independently associated with poor prognosis in elderly patients with atrial fibrillation(HR=1.849,95%CI:1.049-3.259,P=0.033).Conclusions Hyperuricemia is associated with poor prognosis in elderly patients with nonvalvular atrial fibrillation.

关键词

老年人,80以上/心房颤动/高尿酸血症

Key words

Aged,80 and over/Atrial fibrillation/Hyperuricemia

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出版年

2024
中国心血管杂志
卫生部北京医院,天津医科大学

中国心血管杂志

CSTPCDCSCD北大核心
影响因子：0.993
ISSN：1007-5410
参考文献量2
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