Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University , Suzhou, China.
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine , New Orleans, LA, USA.
Neurol Res. 2020 Nov;42(11):923-929. doi: 10.1080/01616412.2020.1792688. Epub 2020 Jul 13.
The prognostic value of uric acid in ischemic stroke remains controversial, and it is unclear whether renal function status modifies the prognostic value of uric acid in ischemic stroke patients.
A total of 3284 acute ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) with creatinine and uric acid measurements were included in this analysis. The primary outcome was a composite of death and major disability (modified Rankin Scale score ≥3) at 1 year after stroke.
The prognostic value of uric acid in ischemic stroke was appreciably modified by patients' renal function status ( interaction <0.05). After multivariate adjustment, higher uric acid level was significantly associated with a better prognosis in patients with normal renal function (odds ratio, 0.61; 95% confidence interval, 0.45-0.83), but not in those with abnormal renal function (odds ratio, 0.87; 95% confidence interval, 0.48-1.55), when two extreme quartiles were compared. Linear association between uric acid and primary outcome was observed among patients with normal renal function ( for linearity = 0.023).
The present study suggests that high serum uric acid concentration is associated with better prognosis in ischemic stroke patients with normal renal function, but not in those with abnormal renal function. The establishment of causality between increased uric acid levels and better stroke prognosis needs more suitably designed randomized clinical trials.
尿酸在缺血性脑卒中中的预后价值仍存在争议，目前尚不清楚肾功能状态是否会改变尿酸对缺血性脑卒中患者预后的预测价值。
本研究共纳入了 3284 例来自中国急性缺血性脑卒中降压试验（CATIS）且同时检测了肌酐和尿酸的急性缺血性脑卒中患者。主要终点为卒中后 1 年时的死亡和主要残疾（改良 Rankin 量表评分≥3）复合终点。
尿酸对缺血性脑卒中的预后价值明显受到患者肾功能状态的影响（交互作用 P<0.05）。在校正多因素后，与正常肾功能患者相比，高尿酸水平与更好的预后显著相关（比值比 0.61；95%置信区间 0.45-0.83），而与异常肾功能患者无关（比值比 0.87；95%置信区间 0.48-1.55），当比较两个极端四分位数时。在肾功能正常的患者中，尿酸与主要终点之间存在线性关联（线性检验 P=0.023）。
本研究表明，在肾功能正常的缺血性脑卒中患者中，高血清尿酸浓度与更好的预后相关，但在肾功能异常的患者中则无此关联。尿酸水平升高与更好的卒中预后之间的因果关系还需要更多设计合理的随机临床试验来证实。
