Okura Takafumi, Higaki Jitsuo, Kurata Mie, Irita Jun, Miyoshi Ken-ichi, Yamazaki Tsutomu, Hayashi Doubun, Kohro Takahide, Nagai Ryozo
Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Japan.
Circ J. 2009 May;73(5):885-91. doi: 10.1253/circj.cj-08-0828. Epub 2009 Mar 31.
The association of elevated serum uric acid (UA) with cardiovascular events in patients with severe coronary artery stenosis was examined.
Patients with stenosis > or = 75% (n=8,832) were followed for "all events" (cardiovascular events and all-cause mortality) for 3 years. The group was divided into quartiles based on baseline UA level. The incidence rate of all events was significantly different among quartiles (58.3, 56.5, 61.2, 76.3/1,000 patients-year, P<0.001). Cox's proportional hazard regression analysis showed that the hazard ratio (HR) for all events was 1.25 [95% confidence interval (CI): 1.07-1.45, P<0.01] in the highest quartile (UA > or = 6.8 mg/dl). The group in which UA increased > or = 1.0 mg/dl after 6 months had significantly higher cardiovascular events rate than the group in which UA did not change (70.6 vs 58.8/1,000 patients-year, P=0.042). Propensity score matching was performed and 4,206 patients were divided into the highest quartile and the rest. High UA remained an independent predictor of all events (HR 1.25, 95%CI 1.06-1.43). However, no significant difference was observed between the group with increased UA > or = 1.0 mg/dl and the group with unchanged UA level.
Elevated UA is an independent predictor of cardiovascular events and all-cause mortality combined in patients with coronary artery stenosis.
研究了严重冠状动脉狭窄患者血清尿酸（UA）升高与心血管事件之间的关联。
对狭窄程度≥75%的患者（n = 8832）进行了3年的“所有事件”（心血管事件和全因死亡率）随访。根据基线UA水平将该组患者分为四分位数。四分位数之间的所有事件发生率有显著差异（58.3、56.5、61.2、76.3/1000患者-年，P<0.001）。Cox比例风险回归分析显示，在最高四分位数（UA≥6.8mg/dl）中，所有事件的风险比（HR）为1.25 [95%置信区间（CI）：1.07 - 1.45，P<0.01]。6个月后UA升高≥1.0mg/dl的组心血管事件发生率显著高于UA未变化的组（70.6 vs 58.8/1000患者-年，P = 0.042）。进行了倾向评分匹配，4206例患者被分为最高四分位数组和其余组。高UA仍然是所有事件的独立预测因素（HR 1.25，95%CI 1.06 - 1.43）。然而，UA升高≥1.0mg/dl的组与UA水平未变化的组之间未观察到显著差异。
UA升高是冠状动脉狭窄患者心血管事件和全因死亡率合并的独立预测因素。
