尿酸与急性ST段抬高型心肌梗死患者急诊PCI术后冠脉血流及预后的相关性研究

发布时间：2018-01-03 17:01

本文关键词：尿酸与急性ST段抬高型心肌梗死患者急诊PCI术后冠脉血流及预后的相关性研究　出处：《南昌大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景：流行病学显示，尿酸水平升高与心血管疾病相关，尿酸是普通人群、冠心病患者不良预后的独立预测因子。研究发现，尿酸升高与冠脉血流受损相关。但是目前尚不清楚尿酸是否能预测急性ST段抬高型心肌梗死（acuteST-elevation myocardial infarction STEMI）患者急诊经皮冠状动脉介入治疗（primary percutaneous coronary intervention PCI）术后冠脉血流受损、以及尿酸是否与STEMI患者短期和长期预后独立相关。研究目的：对住院期间尿酸水平与STEMI患者急诊PCI后冠脉血流以及短期和长期预后的相关性进行研究。研究方法：选取2010年01月至2013年6月就诊于海淀医院、发病在12h内的STEMI并且行急诊PCI的患者。根据实验室检测的尿酸结果将STEMI患者分成两组：高尿酸组（其中男性420umol/l,女性360umol/l），其中男性24例（77.4%）、女性7例（22.6%）；正常尿酸组（其中男性≤420umol/l,女性≤360umol/l），其中男性82例（75.9%）、女性26例（24.1%）。所有患者PCI术后收入CCU进一步治疗。入院后采集所有患者的一般情况、实验室检查结果、经胸超声心脏彩超及冠状动脉造影结果，记录患者住院期间死亡和主要不良心血管情况。患者出院6个月后进行随访，收集患者PCI术后6个月的死亡和主要不良心血管情况。多变量分析住院期间尿酸水平与STEMI患者急诊PCI术后冠脉血流受损相关性、以及尿酸水平与STEMI患者住院期间和PCI术后6个月死亡和主要不良心血管事件的相关性。研究结果：本研究共纳入139名行急诊PCI的STEMI患者，其中男性106例（76.3%），女性33例（23.7%）。高尿酸组31例(22.3％)，正常尿酸组108例(77.7％)。高尿酸组高血压发病率(54.8％vs32.4％，PO.05)、陈旧心肌梗死发病率(19.4％vs8.3％，PO.05)、多支血管病变发病率（61.3％vs37.0％，PO.05)显著高于正常尿酸组；入院后高尿酸组与正常尿酸组心功能KillipⅠ级(54.8％vs73.1％，P=0.06)、KillipⅡ级(12.9％vs18.5％，P=0.47)无统计学差异，但是高尿酸组KillipⅢ级（16.1％vs3.7％，PO.05)、KillipⅣ级（16.1％vs4.6％，PO.05)显著高于正常尿酸组。经胸超声心动图显示，高尿酸组患者的左室射血分数（LVEF）显著低于正常尿酸组（49±15％vs54±11％，PO.05)。冠脉造影检查显示，高尿酸组和低尿酸组无复流（TIMI血流0、1、2级）发生率也存在统计学差异（29.0％vs10.2％，PO.05)。高尿酸组患者住院期间主要不良心血管事件显著高于正常尿酸组（25.8％vs7.4％，PO.05)；两组6个月主要不良心血管事件也存在统计学差异（25.2％vs23.1％，PO.05)。多变量分析表明，在校正了影响因素后，住院期间尿酸水平是STEMI患者急诊PCI术后冠脉血流受损、住院期间不良心血管事件的独立危险因素（分别0R=1.0995%CI1.02-1.18, PO.05；0R=1.0995%CI1.02-1.12, PO.05）。研究结论：住院期间尿酸水平与STEMI患者急诊PCI术后冠脉血流受损独立相关。此外，尿酸是STEMI患者急诊PCI术后短期主要不良心血管事件的独立危险因素。因此我们的研究证实，，作为一项简便、快捷、低廉、可靠的检查手段，尿酸不但能预测STEMI患者急诊PCI术后冠脉血流受损，还是评估STEMI患者危险分层有效的标记物。
[Abstract]:Background: epidemiologic studies suggest that elevated levels of uric acid, uric acid is associated with cardiovascular disease, the general population, independent predictors of poor prognosis of patients with coronary heart disease. The study found that uric acid is associated with impaired coronary flow. But it is unclear whether uric acid can predict acute ST elevation myocardial infarction (acuteST-elevation myocardial infarction STEMI) patients after emergency percutaneous coronary intervention (primary percutaneous coronary intervention PCI) impaired coronary blood flow after operation, and whether uric acid independently associated with STEMI in patients with short-term and long-term prognosis.
Objective: To study the relationship between the level of uric acid during hospitalization and the coronary blood flow after emergency PCI and the short-term and long-term prognosis in patients with STEMI.
Methods: from 2010 to June 2013 in Haidian Hospital from 01 months, the incidence of 12h in the STEMI and emergency PCI patients. According to the results of laboratory tests and uric acid STEMI patients were divided into two groups: high uric acid group (male 420umol/l, female 360umol/l), among which 24 cases were male (77.4%), 7 females (22.6%); normal uric acid group (male = 420umol/l, female 360umol/l), among which 82 cases were male (75.9%), 26 cases were female (24.1%). All the patients with PCI after CCU treatment. Further income generally collected after admission in all patients, results of laboratory examination, transthoracic echocardiography and coronary angiography records of hospitalized patients, adverse cardiovascular death and major. During the follow-up of patients 6 months after discharge, death and major adverse cardiovascular conditions for 6 months were collected after PCI. Multivariate analysis of uric acid during hospitalization The correlation between level and coronary artery blood flow impairment after emergency PCI operation in STEMI patients, and the correlation between uric acid level and death and major adverse cardiovascular events in STEMI patients during hospitalization and 6 months after PCI were also analyzed.
The results of the study:
A total of 139 STEMI patients undergoing emergency PCI were enrolled in this study, including 106 men (76.3%), 33 women (23.7%), 31 patients (22.3%) in hyperuricemia group, and 108 patients (77.7%) in normal uric acid group.
High uric acid group the incidence of hypertension (54.8%vs32.4%, PO.05), old myocardial infarction incidence rate (19.4%vs8.3%, PO.05), multivessel disease incidence rate (61.3%vs37.0%, PO.05) was significantly higher than that in normal uric acid group; after admission, high uric acid group and normal uric acid group Killip heart function grade (54.8%vs73.1%, P=0.06), Killip (grade II 12.9%vs18.5%, P=0.47) had no significant difference, but the high uric acid group of Killip III (16.1%vs3.7%, PO.05), Killip grade (16.1%vs4.6%, PO.05) was significantly higher than that in normal uric acid group. Transthoracic echocardiography showed high uric acid group of patients with left ventricular ejection fraction (LVEF) was significantly lower than the normal uric acid group (49 + 15%vs54 + 11%, PO.05). Coronary angiography showed high uric acid group and low uric acid group of no reflow (TIMI flow 0,1,2) incidence rate there were significant difference (29.0%vs10.2%, PO.05). The main high uric acid group of patients during hospitalization To adverse cardiovascular events was significantly higher than that in normal uric acid group (25.8%vs7.4%, PO.05); the two group of 6 months of major adverse cardiovascular events there were significant difference (25.2%vs23.1%, PO.05). Multivariate analysis showed that in the correction factors, during the period of hospitalization is uric acid impaired coronary blood flow in patients with STEMI after emergency PCI, independent risk period the factors of adverse cardiovascular events in hospital (respectively 0R=1.0995%CI1.02-1.18, PO.05; 0R=1.0995%CI1.02-1.12, PO.05).
The conclusions are as follows:
During hospitalization, uric acid and emergency patients after PCI STEMI impaired coronary flow independently. In addition, uric acid is the independent risk factors of short-term major adverse cardiovascular events in STEMI patients after emergency PCI. Therefore our research confirms that as a simple, fast, inexpensive, reliable inspection method, not only can predict the uric acid in patients with STEMI after emergency PCI impaired coronary flow, or assess the risk stratification of STEMI patients and effective marker.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R542.22

【共引文献】