血清尿酸水平升高与 ST 段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗后的炎症反应增强及短期和长期死亡率增加相关。
Elevated serum uric acid is associated with a greater inflammatory response and with short- and long-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
机构信息
Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
出版信息
Nutr Metab Cardiovasc Dis. 2021 Feb 8;31(2):608-614. doi: 10.1016/j.numecd.2020.10.020. Epub 2020 Nov 3.
BACKGROUND AND AIMS
Despite elevated serum uric acid (eSUA) has been identified as independent risk factor for cardiovascular diseases, its prognostic value in the setting of ST-segment elevation myocardial infarction (STEMI) is still controversial. Although the mechanisms of this possible relationship are unsettled it has been suggested that eSUA could trigger the inflammatory response. This study sought to investigate the association between eSUA with short- and long-term mortality and with inflammatory response in patients with STEMI treated with primary percutaneous coronary intervention (pPCI).
METHODS AND RESULTS
Blood samples were collected on admission and at 24 and 48 h after pPCI: the inflammatory biomarkers C-reactive protein (CRP), neutrophil count and neutrophil to lymphocytes ratio (NLR) were considered. Baseline eSUA was defined as ≥6.8 mg/dl. Cumulative 30-days and 1-year mortalities were estimated using the Kaplan-Meyer analysis. Multivariable analyses were performed by Cox proportional hazard models. In the 2369 patients with STEMI considered, 30-day mortality was 5.8% among patients with eSUA and 2% among patient with normal SUA level (p < 0.001); 1-year mortality was 8.5% vs 4%, respectively (p < 0.001). At multivariable analyses eSUA was an independent predictor of 30-day mortality (HR 1.196, 95%CI 1.006-1.321, p = 0.042) and 1-year mortality (HR 1.178, 95%CI 1.052-1.320, p = 0.005). eSUA patients presented higher values in on admission CRP (p < 0.001) and in neutrophil count and NLR at 24 h (respectively, p = 0.020 and p < 0.001) and at 48 h (p = 0.018 and p < 0.001) compared to patients with normal SUA levels.
CONCLUSIONS
Elevated serum uric acid is associated with higher short- and long-term mortality and with a greater inflammatory response after reperfusion in patients with STEMI treated with primary PCI.
背景与目的
尽管血清尿酸水平升高（eSUA）已被确定为心血管疾病的独立危险因素，但在 ST 段抬高型心肌梗死（STEMI）患者中，其预后价值仍存在争议。尽管这种可能的关系的机制尚不清楚，但有人认为 eSUA 可能引发炎症反应。本研究旨在探讨在接受直接经皮冠状动脉介入治疗（pPCI）的 STEMI 患者中，eSUA 与短期和长期死亡率以及与炎症反应之间的关系。
方法和结果
在 pPCI 后入院时和 24 小时和 48 小时采集血样：考虑了炎症生物标志物 C 反应蛋白（CRP）、中性粒细胞计数和中性粒细胞与淋巴细胞比值（NLR）。将基线 eSUA 定义为≥6.8mg/dl。使用 Kaplan-Meier 分析估计 30 天和 1 年的死亡率。通过 Cox 比例风险模型进行多变量分析。在考虑的 2369 例 STEMI 患者中，eSUA 患者的 30 天死亡率为 5.8%，而正常 SUA 水平患者的死亡率为 2%（p<0.001）；1 年死亡率分别为 8.5%和 4%（p<0.001）。多变量分析显示，eSUA 是 30 天死亡率（HR 1.196，95%CI 1.006-1.321，p=0.042）和 1 年死亡率（HR 1.178，95%CI 1.052-1.320，p=0.005）的独立预测因子。与正常 SUA 水平的患者相比，eSUA 患者入院时 CRP 水平更高（p<0.001），24 小时时的中性粒细胞计数和 NLR 值更高（分别为 p=0.020 和 p<0.001），48 小时时的 CRP、中性粒细胞计数和 NLR 值更高（分别为 p=0.018 和 p<0.001）。
结论
在接受直接 PCI 治疗的 STEMI 患者中，血清尿酸水平升高与短期和长期死亡率升高以及再灌注后的炎症反应增强相关。
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