發(fā)布時間：2018-05-27 17:24

  本文選題：血清尿酸 + 高尿酸血癥　； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：尿酸（uric acid，UA）是人體內(nèi)源性和外源性嘌呤在黃嘌呤氧化酶作用下的代謝終產(chǎn)物，作為機(jī)體內(nèi)代謝紊亂的標(biāo)志物與多種腦血管病危險因素密切相關(guān)。在正常情況下，人體內(nèi)每天尿酸的產(chǎn)生和排泄基本上保持動態(tài)平衡。當(dāng)機(jī)體嘌呤生成過多或腎臟尿酸排出減少時即可導(dǎo)致高尿酸血癥（hyeruricemia，HUA）。HUA與代謝綜合征（metabolic syndrome，MS）的許多組分如高血壓、高血糖、脂代謝紊亂、冠心病、肥胖及胰島素抵抗等密切相關(guān)，并且通過多種作用機(jī)制導(dǎo)致動脈粥樣硬化的發(fā)生與發(fā)展。大量研究表明，高尿酸血癥作為新的腦血管病危險因素可能與缺血性腦卒中的發(fā)生風(fēng)險增加、不良預(yù)后及早期死亡有關(guān)。同時，，也有研究認(rèn)為：UA作為有效的抗氧化劑和自由基清除劑，對急性缺血性腦卒中具有神經(jīng)保護(hù)作用，可以改善卒中預(yù)后、減少卒中復(fù)發(fā)。但目前血尿酸對缺血性腦卒中的作用仍然存在爭議，基于此，本研究通過大樣本、回顧性分析，觀察缺血性腦卒中急性期血尿酸水平，評價其與卒中短期預(yù)后的相關(guān)關(guān)系。 方法:采用回顧性研究，以2009年3月～2013年9月收住河北醫(yī)科大學(xué)第三醫(yī)院神經(jīng)內(nèi)科的急性腦梗死患者作為研究對象，入組患者為依據(jù)經(jīng)典TOAST病因分型明確診斷為大動脈粥樣硬化型（large-arteryatherosclerosis，LAA）及小動脈閉塞型腦梗死型（small-artery occlusion，SAO）患者，共1085例。所有入組患者均具有詳細(xì)的臨床資料包括：人口構(gòu)成情況、血管病危險因素病史及家族史、頭顱結(jié)構(gòu)影像學(xué)及血管影像學(xué)如經(jīng)顱多普勒超聲、頸動脈彩超、血液學(xué)檢查結(jié)果及基線狀態(tài)神經(jīng)功能缺損程度及病情轉(zhuǎn)歸情況記錄等。排除如下患者：（1）臨床資料不全，難以進(jìn)行TOAST病因分型者、缺乏血清尿酸檢測結(jié)果者，以及心源性栓塞、其他病因、未明原因的卒中患者；（2）因既往疾病所遺留后遺癥而難以評估病情者；（3）痛風(fēng)患者；（4）患有心、肝、腎等嚴(yán)重功能不全（慢性腎炎、高血壓性腎病、糖尿病性腎�。┱撸唬�5）患有精神疾病者；（6）高血壓危象、高血壓腦病者；（7）應(yīng)用噻嗪類利尿劑者。所有患者均于發(fā)病后7天內(nèi)入院，平均住院時間為14天。對于原始病例中無NIHSS評分記錄的患者，依據(jù)入院、出院時臨床查體所見進(jìn)行評分。短期不良預(yù)后的判斷標(biāo)準(zhǔn)包括：(1）住院期間死亡；(2）依據(jù)美國國立衛(wèi)生研究院腦卒中量表（National Institute of Health Stroke Scale，NIHSS）標(biāo)準(zhǔn)評分，出院時NIHSS評分與入院基線狀態(tài)NIHSS評分下降的百分比作為指標(biāo)，即（入院時NIHSS評分-出院時NIHSS評分）/入院時NIHSS評分40%判斷為預(yù)后不良。 采用SPSS16.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。計(jì)數(shù)資料以陽性例數(shù)、構(gòu)成比表示，采用χ2檢驗(yàn)。計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差形式表示，采用t檢驗(yàn)。多因素分析采用Logistic回歸分析。P 0.05判定為差異有統(tǒng)計(jì)學(xué)意義。比較不同類型卒中患者高尿酸血癥發(fā)病率；將入組患者人口構(gòu)成情況及TOAST分型、高血壓病、糖尿病、高脂血癥、冠心病、心腦血管病家族史、血尿酸、血尿素、血肌酐和血紅蛋白水平作為自變量，將單因素分析有統(tǒng)計(jì)學(xué)意義的指標(biāo)再進(jìn)一步通過多因素相關(guān)分析，評價急性腦梗死患者HUA的獨(dú)立危險因素及與卒中短期預(yù)后的相關(guān)性。 結(jié)果：1、1085例患者滿足入組標(biāo)準(zhǔn)納入本研究。其中，男性709例（65.35%），女性376例（36.45%）；LAA、SAO患者分別為747例(68.85%)、338例(31.15%)；依據(jù)出院與基線狀態(tài)NIHSS評分下降百分比，預(yù)后不良患者共346例（31.89%），其中住院期間死亡10例，預(yù)后良好患者共739例（61.11%）。所有被研究患者高尿酸血癥（hyeruricemia，HUA）的發(fā)病率11.15%，LAA組患者高尿酸血癥的發(fā)病率14.46%，顯著高于SAO組患者3.85%（χ2=22.866，OR=4.225，P=0.000）；低血尿酸水平患者占1.29%，血尿酸水平異常的總發(fā)病率12.44%。預(yù)后不良患者中14.74%伴發(fā)HUA，低血尿酸水平患者占2.02%，尿酸水平異常的總發(fā)病率為16.76%。2、以HUA為因變量，分別以高血壓病、糖尿病、高脂血癥等腦血管病危險因素為自變量，通過單因素Logistic回歸分析發(fā)現(xiàn):高血壓病、高脂血癥、高尿素血癥、高肌酐血癥是HUA發(fā)生的危險因素。而性別、年齡、吸煙、飲酒、糖尿病、心臟病、心腦血管病家族史、低血紅蛋白與HUA發(fā)生無顯著相關(guān)性。在調(diào)整了年齡、性別等因素后，進(jìn)一步經(jīng)多因素Logistic回歸分析顯示：高肌酐血癥（OR=5.767,95%CI:3.101～10.723, P=0.000）、LAA（OR=4.332,95%CI:2.356～7.966,P=0.000）、高尿素血癥（OR=2.307,95%CI:1.283～4.148, P=0.005）、高脂血癥（OR=2.017,95%CI:1.307～3.112, P=0.002)增加HUA的發(fā)病風(fēng)險，為HUA的獨(dú)立危險因素。3、以卒中患者短期出院時神經(jīng)功能缺損程度作為因變量，評價急性缺血性腦卒中短期預(yù)后不良的危險因素。以高血壓病、糖尿病、高脂血癥等腦血管病危險因素為自變量，通過單因素分析發(fā)現(xiàn)：HUA（χ2=6.502，OR=1.652，P=0.011）、尿酸水平異常（χ2=8.558，OR=1.731，P=0.003）、高血壓病、糖尿病、高尿素血癥增加急性缺血性腦卒中患者短期預(yù)后不良的發(fā)生危險。而性別、年齡、LAA、吸煙、高脂血癥、心臟病、心腦血管病家族史、高肌酐血癥、低血紅蛋白與患者短期預(yù)后無顯著相關(guān)性。通過多因素Logistic回歸分析顯示：HUA（OR=1.448，95%CI:0.967～2.168, P=0.072）與急性缺血性腦卒中患者短期預(yù)后不良無相關(guān)性，而高尿素血癥（OR=1.748,95%CI:1.107～2.760, P=0.017）、高血壓病(OR=1.635,95%CI:1.183～2.260, P=0.003)、尿酸水平異常(OR=1.515,95%CI:1.031～2.225, P=0.034)、糖尿�。∣R=1.362,95%CI:1.037～1.790,P=0.026）為急性缺血性腦卒中患者短期預(yù)后不良的獨(dú)立危險因素。 結(jié)論： LAA型腦梗死、高脂血癥患者更易伴發(fā)HUA，尿酸水平異常為卒中患者短期預(yù)后不良的獨(dú)立危險因素，但HUA對急性缺血性腦卒中的短期不良預(yù)后無預(yù)測價值。
[Abstract]:Objective: uric acid (UA) is a metabolic end product of endogenous and exogenous purines under the action of xanthine oxidase. As a marker of metabolic disorders in the body, it is closely related to the risk factors of various cerebrovascular diseases. In normal cases, the production and excretion of uric acid in the human body is basically balanced. High uricemia (hyeruricemia, HUA).HUA and metabolic syndrome (metabolic syndrome, MS) can lead to many components of hyperuricemia (metabolic syndrome, MS), such as hypertension, hyperglycemia, lipid metabolism disorder, coronary heart disease, obesity and insulin resistance, and lead to atherosclerosis through a variety of mechanisms of action. Birth and development. A large number of studies have shown that hyperuricemia as a new risk factor for cerebrovascular disease may be associated with increased risk of ischemic stroke, poor prognosis and early death. At the same time, UA is considered as an effective antioxidant and free radical scavenger, which has neuroprotective effect on acute ischemic stroke. It can improve the prognosis of stroke and reduce the recurrence of stroke. However, the current effect of blood uric acid on ischemic stroke is still controversial. Based on this, this study, through a large sample, retrospective analysis, observed the level of uric acid in the acute phase of ischemic stroke, and evaluated the correlation with the short-term prognosis of stroke.
Methods: a retrospective study was conducted to study the acute cerebral infarction patients in the neurology department of the Third Hospital of Hebei Medical University from March 2009 to September 2013. The patients were diagnosed as large-arteryatherosclerosis (LAA) and cerebral infarction type of small artery occlusion (s) according to the classic TOAST etiological type (s Mall-artery occlusion, SAO) patients, with a total of 1085 cases. All the patients had detailed clinical data including population composition, history of risk factors for vascular diseases, family history, cranial structure imaging, and vascular imaging such as transcranial Doppler ultrasound, carotid color Doppler ultrasound, hematological examination results and baseline state neural function defect process. The following patients were excluded: (1) poor clinical data, difficult to carry out TOAST etiological types, lack of serum uric acid test results, cardiac embolism, other causes, unknown causes of stroke patients; (2) (3) gout patients; (4) suffering from the sequelae of previous diseases; (3) Heart, liver, kidney and other severe dysfunction (chronic nephritis, hypertensive nephropathy, diabetic nephropathy); (5) patients with mental illness; (6) hypertensive crisis, hypertensive encephalopathy; (7) use thiazine diuretics. All patients were admitted to hospital within 7 days after the onset of the disease, the average length of hospitalization was 14 days. No NIHSS score was recorded in the original cases. The patients were assessed on the basis of admission and clinical findings at discharge. The criteria for short-term poor prognosis included: (1) death during hospitalization; (2) according to the National Institutes of Health Stroke Scale (National Institute of Health Stroke Scale, NIHSS) standard score, NIHSS score at discharge and admission baseline state NIHSS score The percentage of fall as an indicator, i.e., NIHSS score at admission (NIHSS score at discharge) / NIHSS score at admission, was 40%.
Statistical analysis was carried out by SPSS16.0 software. The count data were expressed as positive cases and composition ratio, using chi 2 test. The measurement data were represented by mean number of standard deviation and t test. The multiple factor analysis using Logistic regression analysis.P 0.05 was statistically significant. Compared with the incidence of hyperuricemia in different types of stroke patients Rate; the population composition of the patients and TOAST classification, hypertension, diabetes, hyperlipidemia, coronary heart disease, family history of cardio cerebral vascular disease, blood uric acid, blood urea, blood creatinine and hemoglobin levels were used as independent variables, and the statistical indexes of single factor analysis were further analyzed by multi factor correlation analysis to evaluate acute cerebral infarction. Independent risk factors of HUA and its correlation with short-term prognosis in stroke patients.
Results: 11085 patients met the criteria for admission to the study. Among them, 709 (65.35%) and 376 (36.45%) women were male; LAA, SAO patients were 747 (68.85%) and 338 (31.15%); 346 patients (31.89%) had poor prognosis based on the discharge and baseline NIHSS scores. Among them, there were 10 cases of death during hospitalization, and the prognosis was good. There were 739 cases (61.11%). The incidence of hyperuricemia (hyeruricemia, HUA) in all the patients was 11.15%, and the incidence of hyperuricemia in group LAA was 14.46%, significantly higher than that in group SAO (x 2=22.866, OR=4.225, P=0.000), low uric acid level in 1.29%, and the total incidence of abnormal serum uric acid in 12.44%., 1 in poor prognosis patients. 4.74% with HUA, low blood uric acid level in 2.02%, the total incidence of abnormal uric acid level was 16.76%.2, HUA as the dependent variable, hypertension, diabetes, hyperlipidemia and other risk factors of cerebrovascular disease as independent variables, through single factor Logistic regression analysis found: hypertension, hyperlipidemia, high urea, hypercreatinine is H There was no significant correlation between sex, age, smoking, smoking, drinking, diabetes, heart disease, family history of cardiovascular and cerebrovascular diseases, and there was no significant correlation between the incidence of low hemoglobin and HUA. After adjusting the age, sex and other factors, the multiple factor Logistic regression analysis showed that hypercreatinine (OR=5.767,95%CI:3.101 to 10.723, P=0.000), LAA (OR=4.) 332,95%CI:2.356 ~ 7.966, P=0.000), hyperurea (OR=2.307,95%CI:1.283 ~ 4.148, P=0.005), hyperlipidemia (OR=2.017,95%CI:1.307 to 3.112, P=0.002) increased the risk of HUA, an independent risk factor for HUA, which was a dependent variable in the short-term discharge of stroke patients, to evaluate the short stroke of acute ischemic stroke. The risk factors of poor prognosis. The risk factors of cerebrovascular disease such as hypertension, diabetes and hyperlipidemia are independent variables. Through single factor analysis, it is found that HUA (x 2=6.502, OR=1.652, P=0.011), abnormal uric acid level (x 2=8.558, OR=1.731, P=0.003), hypertension, diabetes, and high urea increase the short term of acute ischemic stroke There was no significant correlation between sex, age, LAA, smoking, hyperlipidemia, heart disease, family history of cardio cerebrovascular disease, hypercreatinine, and low hemoglobin, and short term prognosis. Multiple factor Logistic regression analysis showed that HUA (OR=1.448,95%CI:0.967 ~ 2.168, P=0.072) and acute ischemic stroke patients were short Poor prognosis was not associated with high urea (OR=1.748,95%CI:1.107 ~ 2.760, P=0.017), hypertension (OR=1.635,95%CI:1.183 to 2.260, P=0.003), abnormal uric acid (OR=1.515,95%CI:1.031 to 2.225, P=0.034), diabetes (OR=1.362,95%CI:1.037 to 1.790, P=0.026) for the short-term prognosis of acute ischemic stroke patients. Independent risk factors.
Conclusion:
Patients with type LAA cerebral infarction and hyperlipidemia are more likely to be associated with HUA. The abnormal level of uric acid is an independent risk factor for the short term prognosis of stroke patients, but HUA has no predictive value for the short-term prognosis of acute ischemic stroke.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 周瑋;;不同TOAST病因分型的急性腦梗死患者血尿酸水平分析[J];內(nèi)科;2015年05期

相關(guān)碩士學(xué)位論文 前1條

1 李秀文;血清ApoA1、血尿酸水平與缺血性腦血管病患者頸動脈斑塊類型的相關(guān)性研究[D];河北醫(yī)科大學(xué);2016年

本文編號：1943120