血清尿酸变化对卒中及其亚型风险的影响。
Effect of changes in serum uric acid on the risk of stroke and its subtypes.
机构信息
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
出版信息
Nutr Metab Cardiovasc Dis. 2022 Jan;32(1):167-175. doi: 10.1016/j.numecd.2021.09.017. Epub 2021 Sep 22.
BACKGROUND AND AIMS
The role of serum uric acid (SUA) in stroke remains controversial and analyses of changes in SUA and stroke are limited. The objective of the study was to investigate the associations of changes in SUA with stroke and its subtypes (ischemic and hemorrhagic stroke).
METHODS AND RESULTS
A total of 51 441 participants (mean age 52.69 ± 11.71 years) without history of myocardial infarction or stroke were enrolled. Participants were divided into four groups based on SUA level changes during 2006 and 2010: stable low, increasing, decreasing, and stable high. SUA score was quantified on a 3-point scale with 1 point awarded for hyperuricemia at either year 2006, 2008 or 2010. Multivariate Cox proportion models were used to calculated hazard ratios (HRs) and their 95% confidence intervals (CIs). During 7.03-year follow up, 1611 stroke (1410 ischemic stroke, 199 hemorrhagic stroke, and 47 subarachnoid hemorrhage) were identified. Participants with stable high SUA had higher risk of hemorrhagic stroke, the HR was 1.93 (95% CI: 1.06-3.51), compared to those with stable low SUA. Furthermore, cumulative high SUA exposure also increased the risk of hemorrhagic stroke, the HR (95%CI) was 2.99 (1.55-5.74), compared with cumulative low SUA exposure. However, no significant evidence indicated changes in SUA was associated with the risk of total and ischemic stroke, the HRs (95% CIs) were 0.98 (0.74-1.29) and 0.88 (0.65-1.19), respectively.
CONCLUSIONS
Stable high SUA was positively associated with the risk of hemorrhagic stroke, but not with total and ischemic stroke risk.
背景与目的
血清尿酸（SUA）在中风中的作用仍存在争议，且对 SUA 变化与中风及其亚型（缺血性和出血性中风）关系的分析有限。本研究旨在探讨 SUA 变化与中风及其亚型（缺血性和出血性中风）的相关性。
方法和结果
共纳入 51441 名（平均年龄 52.69±11.71 岁）无心肌梗死或中风病史的参与者。根据 2006 年和 2010 年 SUA 水平的变化，将参与者分为四组：稳定低值、升高、降低和稳定高值。SUA 评分采用 3 分制，2006 年、2008 年或 2010 年任何一年存在高尿酸血症得 1 分。采用多变量 Cox 比例模型计算风险比（HR）及其 95%置信区间（CI）。在 7.03 年的随访期间，共发生 1611 例中风（1410 例缺血性中风、199 例出血性中风和 47 例蛛网膜下腔出血）。与稳定低值 SUA 相比，稳定高值 SUA 组出血性中风风险更高，HR 为 1.93（95%CI：1.06-3.51）。此外，累积高 SUA 暴露也增加了出血性中风的风险，HR（95%CI）为 2.99（1.55-5.74），与累积低 SUA 暴露相比。然而，没有证据表明 SUA 的变化与总中风和缺血性中风的风险相关，HR（95%CI）分别为 0.98（0.74-1.29）和 0.88（0.65-1.19）。
结论
稳定的高 SUA 与出血性中风的风险呈正相关，但与总中风和缺血性中风的风险无关。
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