高尿酸血症与心力衰竭患者交感神经激活的预后相关性。
Relation between prognostic impact of hyperuricemia and sympathetic overactivation in patients with heart failure.
机构信息
Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
出版信息
J Cardiol. 2019 Mar;73(3):233-239. doi: 10.1016/j.jjcc.2018.08.008. Epub 2018 Nov 9.
BACKGROUND
Uric acid (UA), which could provide additional prognostic information in patients with heart failure (HF), can activate sympathetic nerve activity and vice versa, thus creating a vicious cycle in the cardiovascular system. However, it remains unclear whether hyperuricemia (UA>7.0mg/dl) can provide prognostic information independent of sympathetic nerve activity.
METHODS
UA and potential prognostic variables including sympathetic nerve activity using microneurography (MSNA) were evaluated in 139 patients with HF (ejection fraction<45%). Primary composite cardiovascular endpoints included cardiovascular death and hospitalization due to HF. Predictors for outcomes were analyzed using univariate, multivariable, and Kaplan-Meier analyses. To determine whether the negative impact of hyperuricemia on outcomes is homogenous, prognostic impacts of hyperuricemia were compared in subgroups of HF. Ejection fraction was followed for 9 months after MSNA measurement in 102 patients.
RESULTS
During a follow-up period of 1636 days, 54 patients fulfilled the primary composite endpoint of cardiovascular death or HF hospitalization. Patients with hyperuricemia had a higher cardiovascular event rate than those with normouricemia (p=0.006). On multivariable Cox proportional hazard analysis, hyperuricemia, higher MSNA, and β-blocker dose were independent predictors of cardiovascular events. In subgroup analyses, impact of hyperuricemia on outcome was similar in all subgroups except sympathetic nerve activity (interaction, p=0.033). Hyperuricemia had negative impact on cardiovascular event rates (hazard ratio=3.44) in group with higher MSNA (p=0.0002), but not in those with lower MSNA. Additionally, the change in LVEF was also significantly lower in patients who had a higher MSNA burst incidence and hyperuricemia.
CONCLUSION
Hyperuricemia might have detrimental effect on prognosis and cardiac function in HF patients with sympathetic overactivation.
背景
尿酸（UA）可在心力衰竭（HF）患者中提供额外的预后信息，它可以激活交感神经活动，反之亦然，从而在心血管系统中形成恶性循环。然而，目前尚不清楚高尿酸血症（UA>7.0mg/dl）是否可以独立于交感神经活动提供预后信息。
方法
在 139 名射血分数<45%的 HF 患者中评估 UA 和潜在的预后变量，包括使用微神经记录法（MSNA）评估的交感神经活动。主要复合心血管终点包括心血管死亡和因 HF 住院。使用单变量、多变量和 Kaplan-Meier 分析来分析预测因素。为了确定高尿酸血症对预后的负面影响是否一致，在 HF 的亚组中比较了高尿酸血症的预后影响。在 102 名接受 MSNA 测量后的 9 个月内，对 EF 进行了随访。
结果
在 1636 天的随访期间，54 名患者出现了心血管死亡或 HF 住院的主要复合终点。高尿酸血症患者的心血管事件发生率高于正常尿酸血症患者（p=0.006）。在多变量 Cox 比例风险分析中，高尿酸血症、更高的 MSNA 和β受体阻滞剂剂量是心血管事件的独立预测因素。在亚组分析中，除了交感神经活动（交互作用，p=0.033）外，高尿酸血症对预后的影响在所有亚组中相似。高尿酸血症对心血管事件发生率有负面影响（危险比=3.44），在交感神经活动较高的组中（p=0.0002），但在交感神经活动较低的组中则没有。此外，在 MSNA 爆发发生率较高且伴有高尿酸血症的患者中，LVEF 的变化也明显较低。
结论
高尿酸血症可能对交感神经过度激活的 HF 患者的预后和心功能产生不利影响。
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