Correlation between blood uric acid,hematocrit levels,and ischemic stroke in patients with non-valvular atrial fibrillation
-
摘要: 目的:探讨血尿酸(SUA)和红细胞比容(Hct)水平与非瓣膜性心房颤动(房颤)患者脑卒中的关系。方法:连续入选2018年1月-2019年6月于华中阜外医院拟行心脏射频消融术并符合标准的845例非瓣膜性房颤患者,记录所有患者病史资料、SUA以及Hct等化验指标和经胸超声心动图参数,并进行CHA2DS2-VASc评分。对Hct水平进行分类:高Hct(男≥49%,女≥44%),正常Hct(男42%~49%,女37%~44%),低Hct(男≤42%,女≤37%)。依据既往病史及头颅CT或MRI检查,将入选患者分为卒中组(171例)和非卒中组(674例)。分析房颤脑卒中与各潜在危险因素之间的关系。结果:卒中组年龄、BMI、血肌酐、肾小球滤过率、D-二聚体、B型利钠肽前体、左心房内径、CHA2DS2-VASc评分明显增大,左心室射血分数降低,与非卒中组相比差异均有统计学意义(均P<0.05)。卒中组高血压和冠心病的患病率均更高(均P<0.001)。卒中组SUA高于非卒中组[(293.2±70.2)μmmol/L∶(375.0±72.6)μmmol/L],而Hct水平明显低于非卒中组[(42.0±4.7)%∶(39.6±5.1)%],差异均有统计学意义(均P<0.001)。多因素Logistic回归分析显示,SUA(OR=1.025,95%CI:1.017~1.032,P<0.001)和低Hct(OR=3.327,95%CI:1.476~7.500,P=0.004)是房颤脑卒中的独立危险因素。根据ROC曲线确定SUA水平的最佳截点值为321.5μmol/L,ROC曲线下面积为0.801(95%CI:0.767~0.835),敏感性为80%,特异性为69%。结论:高SUA(≥321.5μmol/L)和低Hct水平(男≤42%,女≤37%)是非瓣膜性房颤患者发生脑卒中的独立危险因素。Abstract: Objective: To investigate the relationship between blood uric acid(SUA), hematocrit(Hct) levels, and stroke in patients with non-valvular atrial fibrillation.Methods: A total of 845 patients with non-valvular atrial fibrillation who were planned to undergo cardiac radiofrequency ablation in Huazhong Fuwai Hospital from January 2018 to June 2019 were continuously selected. Medical history data, SUA, hematocrit, and transthoracic echocardiographic parameters were recorded. CHA2 DS2-VASc score was measured. The HCT levels were classified as high(male ≥ 49%, female ≥ 44%), normal(male 42%-49%, female 37%-44%), and low(male ≤ 42%, female ≤ 37%). Based on the past medical history and head CT or MRI, all patients were divided into stroke group(n=171) and non-stroke group(n=674). The relationship between stroke and various potential risk factors were analyzed.Results: In the stroke group, age, body mass index, blood uric acid, blood creatinine, glomerular filtration rate, D-dimer, pro-BNP, left atrial diameter, CHA2 DS2-VASc score increased, and left ventricular ejection fraction decreased, significantly(all P<0.05). The prevalence of hypertension and coronary heart disease was higher in the stroke group(P<0.001). The SUA level in the stroke group was significantly higher than that in the non-stroke group[(293.2±70.2) μmmol/L vs(375.0±72.6) μmmol/L, P<0.001], while the Hct level in the stroke group was significantly lower than that in the non-stroke group[(42.0±4.7)% vs(39.6±5.1)%, P<0.001]. Multivariate Logistic regression analysis showed that SUA(OR=1.025, 95%CI: 1.017-1.032, P<0.001) and low Hct(OR=3.327, 95%CI: 1.476-7.500, P=0.004) were independent risk factors for stroke. According to the receiver operating characteristic(ROC) curve, the optimal cut-off point of SUA level was 321.5 μmol/L, the area under the ROC curve was 0.801(95%CI: 0.767-0.835), the sensitivity was 80%, and the specificity was 69%.Conclusion: High SUA(≥321.5 μmol/L) and low Hct level(male ≤ 42%, female ≤ 37%) are independent risk factors for stroke in patients with non-valvular atrial fibrillation.
-
Key words:
- atrial fibrillation /
- nonvalvular /
- stroke /
- blood uric acid /
- hematocrit
-
[1] Camm AJ,Kirchhof P,Lip GY,et al.Guidelines for the management of atrial fibrillation:the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology(ESC)[J].Europace,2010,12(10):1360-1420.
[2] Wolf PA,Abbott RD,Kannel WB.Atrial fibrillation as an independent risk factor for stroke:the Framingham Study[J].Stroke,1991,22(8):983-8.
[3] 国家心血管病医疗质量控制中心专家委员会心房颤动专家工作组.2019年中国心房颤动医疗质量控制报告[J].中国循环杂志,2020,35(5):427-437.
[4] Iliesiu A,Campeanu A,Dusceac D.Serum uric acid and cardiovascular disease[J].Maedica(Bucur),2010,5(3):186-92.
[5] Ono K.How Is Uric Acid Related to Atrial Fibrillation?[J].Circ J,2019,83(4):705-706.
[6] Kuwabara M,Niwa K,Nishihara S,et al.Hyperuricemia is an independent competing risk factor for atrial fibrillation[J].Int J Cardiol,2017,231:137-142.
[7] Mantovani A,Rigolon R,Civettini A,et al.Hyperuricemia is associated with an increased prevalence of paroxysmal atrial fibrillation in patients with type 2 diabetes referred for clinically indicated 24-h Holter monitoring[J].J Endocrinol Invest,2018,41(2):223-231.
[8] Hidru TH,Tang Y,Liu F,et al.Does Serum Uric Acid Status Influence the Association Between Left Atrium Diameter and Atrial Fibrillation in Hypertension Patients?[J].Front Cardiovasc Med,2020,7:594788.
[9] Li S,Cheng J,Cui L,et al.Cohort Study of Repeated Measurements of Serum Urate and Risk of Incident Atrial Fibrillation[J].J Am Heart Assoc,2019,8(13):e012020.
[10] 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.
[11] Li J,Muraki I,Imano H,et al.Serum uric acid and risk of stroke and its types:the Circulatory Risk in Communities Study(CIRCS)[J].Hypertens Res,2020,43(4):313-321.
[12] Stavropoulos K,Imprialos KP,Bouloukou S,et al.Hematocrit and stroke:a forgotten and neglected link?[J].Semin Thromb Hemost,2017,43(6):591-598.
[13] Kiyohara Y,Ueda K,Hasuo Y,et al.Hematocrit as a risk factor of cerebral infarction:long-term prospective population survey in a Japanese rural community[J].Stroke,1986,17(4):687-692.
[14] Gagnon DR,Zhang TJ,Brand FN,et al.Hematocrit and the risk of cardiovascular disease--the Framingham study:a 34-year follow-up[J].Am Heart J,1994,127(3):674-682.
[15] Gotoh S,Hata J,Ninomiya T,et al.Hematocrit and the risk of cardiovascular disease in a Japanese community:The Hisayama Study[J].Atherosclerosis,2015,242(1):199-204.
[16] Levey AS,Bosch JP,Lewis JB,et al.A more accurate method to estimate glomerular filtration rate from serum creatinine:a new prediction equation.Modification of Diet in Renal Disease Study Group[J].Ann Intern Med,1999,130(6):461-470.
[17] 濮存莹,廖深根,郑旭辉,等.高尿酸血症预测急性心力衰竭患者长期预后的临床价值[J].临床心血管病杂志,2019,35(6):521-525.
[18] 王钧,李幸,贾璐,等.血尿酸水平与冠状动脉薄纤维帽粥样硬化斑块的相关性研究[J].临床心血管病杂志,2019,35(3):244-250.
[19] Zapolski T,Waciński P,Kondracki B,et al.Uric acid as a link between renal dysfunction and both pro-inflammatory and prothrombotic state in patients with metabolic syndrome and coronary artery disease[J].Kardiol Pol,2011,69(4):319-326.
[20] Yu MA,Sánchez-Lozada LG,Johnson RJ,et al.Oxidative stress with an activation of the renin-angiotensin system in human vascular endothelial cells as a novel mechanism of uric acid-induced endothelial dysfunction[J].J Hypertens,2010,28(6):1234-1242.
[21] 谷文静,付荣凤,鞠满凯,等.真性红细胞增多症患者生存现状及基因突变分析[J].临床血液学杂志,2019,32(9):672-676.
[22] 刘苗苗,郭涛.骨髓增殖性肿瘤血栓事件的治疗现状[J].临床血液学杂志,2021,34(1):9-12.
[23] Gahungu N,Judkins C,Gabbay E,et al.Advances in screening for undiagnosed atrial fibrillation for stroke prevention and implications for patients with obstructive sleep apnoea:a literature review and research agenda[J].Sleep Med,2019,57:107-114.
[24] Gami AS,Hodge DO,Herges RM,et al.Obstructive sleep apnea,obesity,and the risk of incident atrial fibrillation[J].J Am Coll Cardiol,2007,49(5):565-571.
[25] Tyagi T,Ahmad S,Gupta N,et al.Altered expression of platelet proteins and calpain activity mediate hypoxia-induced prothrombotic phenotype[J].Blood,2014,123(8):1250-1260.
[26] Eltzschig HK,Carmeliet P.Hypoxia and inflammation[J].N Engl J Med,2011,364(7):656-665.
计量
- 文章访问数: 817
- PDF下载数: 239
- 施引文献: 0