Luo D L, Zhang C J, Huang Y G, Huang T, Li H Z
Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Cardiovascular Institute, Guangzhou 510000, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Jun 24;45(6):496-500. doi: 10.3760/cma.j.issn.0253-3758.2017.06.011.
The growing body of literature showed a link between uric acid and pulmonary hypertension (PH), but the impact of hyperuremia on outcome of patients with PH has not been well defined. Therefore, the present study was performed to analyze the impact of uric acid on outcome of PH patients. One hundred seventy-three PH patients (112 females, mean age 38 years old), who were hospitalized in our department between January 2010 and December 2015, were included in our study, the PH diagnosis was made based on right heart catheterization examination result (mean pulmonary artery pressure≥25 mmHg(1 mmHg=0.133 kPa)). PH patients were divided into mild to moderate PH group (Rp/Rs≤0.6, =97) and severe PH group (Rp/Rs>0.6, =76). Fifty-one patients (33 females, mean age 45 years old) without PH based on right heart catheterization were included as control subjects. All participants were followed up for a median of 24 months(6-71 months). Clinical endpoints were defined as cardiogenic death or heart-and-lung transplantation. Uric acid was positively correlated with pulmonary vascular resistance(=0.398, <0.01), systemic vascular resistance(=0.244, <0.01) and mean right atrial pressure (=0.26, <0.01), and was negatively correlated with cardiac index(=-0.278, <0.01)and mixed venous oxygen saturation (=-0.322, <0.01)in PH patients. Serum uric acid level was significantly higher in patients with severe PH than in patients with mild-to-moderate PH and the control subjects (both <0.05). According to the receiver operating characteristic curve (ROC), 425.5 μmol/L was found to be the best cut-off value of serum uric acid level to predict the outcome of PH patients (sensitivity 50%, specificity 72%). During follow-up, patients with higher level of uric acid (>425.5 μmol/L) were linked with poorer clinical outcome compared to patients with uric acid <425.5 μmol/L(=0.027). Our findings suggests that uric acid is associated with the severity of PH and higher uric acid level serves as an important predictor for poor clinical outcome of PH patients.
越来越多的文献表明尿酸与肺动脉高压（PH）之间存在联系，但高尿酸血症对PH患者预后的影响尚未明确界定。因此，本研究旨在分析尿酸对PH患者预后的影响。本研究纳入了2010年1月至2015年12月期间在我科住院的173例PH患者（112例女性，平均年龄38岁），PH诊断基于右心导管检查结果（平均肺动脉压≥25 mmHg（1 mmHg = 0.133 kPa））。PH患者分为轻度至中度PH组（Rp/Rs≤0.6，n = 97）和重度PH组（Rp/Rs>0.6，n = 76）。51例基于右心导管检查无PH的患者（33例女性，平均年龄45岁）作为对照。所有参与者的中位随访时间为24个月（6 - 71个月）。临床终点定义为心源性死亡或心肺移植。在PH患者中，尿酸与肺血管阻力（r = 0.398，P < 0.01）、体循环血管阻力（r = 0.244，P < 0.01）和平均右心房压力（r = 0.26，P < 0.01）呈正相关，与心脏指数（r = -0.278，P < 0.01）和混合静脉血氧饱和度（r = -0.3- 22，P < 0.01）呈负相关。重度PH患者的血清尿酸水平显著高于轻度至中度PH患者和对照（均P < 0.05）。根据受试者工作特征曲线（ROC），发现425.5 μmol/L是预测PH患者预后的血清尿酸水平的最佳截断值（敏感性50%，特异性72%）。随访期间，尿酸水平较高（>425.5 μmol/L）的患者与尿酸水平<# 425.5 μmol/L的患者相比，临床预后较差（P = 0.027）。我们的研究结果表明，尿酸与PH的严重程度相关，较高的尿酸水平是PH患者临床预后不良的重要预测指标。
