Tamariz Leonardo, Harzand Arash, Palacio Ana, Verma Sameer, Jones John, Hare Joshua
Division of General Internal Medicine, Department of Medicine, Miller School of Medicine, University of Miami, FL 33136, USA.
Congest Heart Fail. 2011 Jan-Feb;17(1):25-30. doi: 10.1111/j.1751-7133.2011.00200.x. Epub 2011 Jan 27.
Serum uric acid (SUA) is a product of xanthine oxidase (XO). Apoptosis and tissue hypoxia lead to increased purine catabolism, which, in turn, increases XO activity and subsequently SUA levels. The purpose of this study was to perform a meta-analysis to evaluate the evidence supporting SUA as a predictor of all-cause mortality in patients with heart failure (HF) and to determine the SUA cut-off for the increase in risk. A search of the MEDLINE database (1966 to March 2009) supplemented by manual searches of bibliographies of key relevant articles was performed. The authors selected all cohort studies in which SUA was measured and mortality was reported in patients with HF. The pooled relative risk (RR) with the corresponding 95% confidence interval (CI) for all-cause mortality using the fixed-effects method was calculated. The effects of SUA on all-cause mortality at different SUA cut-offs using meta-regression was evaluated. The search strategy yielded 358 studies, of which only 6 met our eligibility criteria. The studies, however, comprised 1456 evaluable patients with HF, with a median ejection fraction of 32% (range, 26%-40%). The RR of all-cause mortality was 2.13 (95% CI, 1.78-2.55) for SUA>6.5 mg/dL compared with <6.5 mg/dL SUA level. There was a linear association (P<.01) between SUA and mortality after 7 mg/dL. Uric acid is an important prognostic marker for all-cause mortality in HF. SUA levels >7 mg/dL are associated with higher all-cause mortality.
血清尿酸（SUA）是黄嘌呤氧化酶（XO）的产物。细胞凋亡和组织缺氧导致嘌呤分解代谢增加，进而增加XO活性，随后使SUA水平升高。本研究的目的是进行一项荟萃分析，以评估支持SUA作为心力衰竭（HF）患者全因死亡率预测指标的证据，并确定增加风险的SUA临界值。我们检索了MEDLINE数据库（1966年至2009年3月），并通过人工检索关键相关文章的参考文献进行补充。作者选择了所有测量了SUA并报告了HF患者死亡率的队列研究。使用固定效应方法计算全因死亡率的合并相对风险（RR）及相应的95%置信区间（CI）。使用Meta回归评估不同SUA临界值下SUA对全因死亡率的影响。检索策略共获得358项研究，其中只有6项符合我们的纳入标准。然而，这些研究包括1456例可评估的HF患者，中位射血分数为32%（范围为26%-40%）。与SUA<6.5mg/dL水平相比，SUA>6.5mg/dL时全因死亡率的RR为2.13（95%CI，1.78-2.55）。SUA在7mg/dL之后与死亡率之间存在线性关联（P<0.01）。尿酸是HF患者全因死亡率的重要预后标志物。SUA水平>7mg/dL与更高的全因死亡率相关。
