Newman Edward J, Rahman Fariel S, Lees Kennedy R, Weir Christopher J, Walters Matthew R
Acute Stroke Unit, University Division of Cardiovascular and Medical Sciences, Gardiner Institute, Western Infirmary, Glasgow, UK.
Diabetes Metab Res Rev. 2006 Jan-Feb;22(1):79-82. doi: 10.1002/dmrr.585.
Type 2 diabetes is a risk factor for stroke and confers increased risk of poor outcome and further vascular events following stroke. Hyperuricaemia occurs commonly in patients with type 2 diabetes, but its significance as a predictor of outcome following stroke is uncertain. We sought to investigate the prognostic significance of elevated serum urate concentration in diabetic subjects following stroke.
We studied a cohort of type 2 diabetes patients presenting to our unit with computed tomography-confirmed acute stroke. Fasting blood samples were drawn within 24 h of admission for urate concentration and standard battery of biochemistry and hematological tests. Information on age, stroke type, prior hypertension, smoking status, resolution time of symptoms and National Institutes of Health Stroke Score was collated. The main outcome event was time to myocardial infarction, recurrent stroke or vascular death, as defined in the CAPRIE trial. Stepwise proportional hazards regression was used to estimate the effect of the above variables on event-free survival following stroke.
One hundred and forty patients were studied. Median follow-up duration was 974 days (IQR 163 to 1830 days). Sixty-four patients suffered an outcome event. Urate levels of greater than 0.42 mmol/L (p < 0.001) and an increasing NIHSS score (p < 0.001) independently predicted increased likelihood of suffering an event.
Elevated urate concentration is significantly and independently associated with increased risk of future vascular events in diabetic stroke patients. Further studies to elucidate the mechanism of this observation are required.
2型糖尿病是中风的危险因素，会增加中风后预后不良及发生更多血管事件的风险。高尿酸血症在2型糖尿病患者中很常见，但其作为中风后预后预测指标的意义尚不确定。我们旨在研究中风后糖尿病患者血清尿酸浓度升高的预后意义。
我们研究了一组因计算机断层扫描确诊为急性中风而前来我院就诊的2型糖尿病患者。入院24小时内采集空腹血样检测尿酸浓度以及进行一系列标准的生化和血液学检查。收集患者的年龄、中风类型、既往高血压病史、吸烟状况、症状缓解时间及美国国立卫生研究院卒中量表评分等信息。主要结局事件为心肌梗死、复发性中风或血管性死亡的发生时间，如CAPRIE试验所定义。采用逐步比例风险回归分析来估计上述变量对中风后无事件生存的影响。
共研究了140例患者。中位随访时间为974天（四分位间距163至1830天）。64例患者发生了结局事件。尿酸水平高于0.42 mmol/L（p<0.001）以及美国国立卫生研究院卒中量表评分增加（p<0.001）独立预测了发生事件的可能性增加。
尿酸浓度升高与糖尿病中风患者未来发生血管事件的风险显著且独立相关。需要进一步研究以阐明这一观察结果的机制。
