临床荟萃
臨床薈萃
림상회췌
CLINICAL FOCUS
2015年
1期
6-12
,共7页
余志敏%郑雅芬%张光宇%王智泉
餘誌敏%鄭雅芬%張光宇%王智泉
여지민%정아분%장광우%왕지천
心房颤动%尿酸%Meta 分析
心房顫動%尿痠%Meta 分析
심방전동%뇨산%Meta 분석
atrial fibrillation%uric acid%meta-analysis
目的：系统评价血清尿酸（serum uric acid，SUA）与心房颤动（atrial fibrillation，AF）发病的关系。方法计算机检索 PubMed、EMbase、CNKI、维普数据库、万方数据库，查找所有 SUA 与 AF 发病关系的病例对照研究及队列研究，检索时限为从建库至2014年9月30日。同时手工检索纳入研究的参考文献。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的质量后，采用 stata 12．0软件进行 Meta 分析。结果纳入17篇病例对照研究和7篇队列研究，共174454例患者。Meta 分析显示：①AF 组 SUA 水平高于非 AF 组（SMD＝0．64，95％ CI ＝0．47～0．82，P ＜0．01）；②高尿酸组较对照组 AF 发病率明显升高（RR ＝1．65，95％ CI ＝1．26～2．16，P ＜0．01）；③在高血压人群中，AF 组 SUA 的水平高于非 AF 组（SMD＝0．67，95％ CI ＝0．11～1．23，P ＜0．05）；在慢性心力衰竭（CHF）人群中，AF 组 SUA 水平高于非 AF 组（SMD＝0．27，95％ CI ＝0．01～0．52，P ＜0．05）；④AF 亚型分析表明，阵发性 AF 组（SMD＝0．38，95％ CI ＝0．16～0．59，P ＜0．01）、永久性 AF 组（SMD＝1．44，95％ CI ＝1．18～1．70，P ＜0．01）的 SUA 水平显著高于非 AF 组；而持续性 AF 组与对照组间 SUA 差异无统计学意义（SMD＝1．04，95％ CI ＝0．27～1．82，P ＞0．05）；阵发性 AF 组的 SUA 水平显著低于永久性 AF 组（SMD＝－1．19，95％ CI ＝－1．97～－0．42，P ＜0．01）。结论不论在普通人群还是高血压、CHF 人群中，AF 患者的 SUA 水平均明显升高。现有证据表明高尿酸血症可能与 AF 发病有关。
目的：繫統評價血清尿痠（serum uric acid，SUA）與心房顫動（atrial fibrillation，AF）髮病的關繫。方法計算機檢索 PubMed、EMbase、CNKI、維普數據庫、萬方數據庫，查找所有 SUA 與 AF 髮病關繫的病例對照研究及隊列研究，檢索時限為從建庫至2014年9月30日。同時手工檢索納入研究的參攷文獻。由2位評價員按照納入與排除標準獨立篩選文獻、提取資料和評價納入研究的質量後，採用 stata 12．0軟件進行 Meta 分析。結果納入17篇病例對照研究和7篇隊列研究，共174454例患者。Meta 分析顯示：①AF 組 SUA 水平高于非 AF 組（SMD＝0．64，95％ CI ＝0．47～0．82，P ＜0．01）；②高尿痠組較對照組 AF 髮病率明顯升高（RR ＝1．65，95％ CI ＝1．26～2．16，P ＜0．01）；③在高血壓人群中，AF 組 SUA 的水平高于非 AF 組（SMD＝0．67，95％ CI ＝0．11～1．23，P ＜0．05）；在慢性心力衰竭（CHF）人群中，AF 組 SUA 水平高于非 AF 組（SMD＝0．27，95％ CI ＝0．01～0．52，P ＜0．05）；④AF 亞型分析錶明，陣髮性 AF 組（SMD＝0．38，95％ CI ＝0．16～0．59，P ＜0．01）、永久性 AF 組（SMD＝1．44，95％ CI ＝1．18～1．70，P ＜0．01）的 SUA 水平顯著高于非 AF 組；而持續性 AF 組與對照組間 SUA 差異無統計學意義（SMD＝1．04，95％ CI ＝0．27～1．82，P ＞0．05）；陣髮性 AF 組的 SUA 水平顯著低于永久性 AF 組（SMD＝－1．19，95％ CI ＝－1．97～－0．42，P ＜0．01）。結論不論在普通人群還是高血壓、CHF 人群中，AF 患者的 SUA 水平均明顯升高。現有證據錶明高尿痠血癥可能與 AF 髮病有關。
목적：계통평개혈청뇨산（serum uric acid，SUA）여심방전동（atrial fibrillation，AF）발병적관계。방법계산궤검색 PubMed、EMbase、CNKI、유보수거고、만방수거고，사조소유 SUA 여 AF 발병관계적병례대조연구급대렬연구，검색시한위종건고지2014년9월30일。동시수공검색납입연구적삼고문헌。유2위평개원안조납입여배제표준독립사선문헌、제취자료화평개납입연구적질량후，채용 stata 12．0연건진행 Meta 분석。결과납입17편병례대조연구화7편대렬연구，공174454례환자。Meta 분석현시：①AF 조 SUA 수평고우비 AF 조（SMD＝0．64，95％ CI ＝0．47～0．82，P ＜0．01）；②고뇨산조교대조조 AF 발병솔명현승고（RR ＝1．65，95％ CI ＝1．26～2．16，P ＜0．01）；③재고혈압인군중，AF 조 SUA 적수평고우비 AF 조（SMD＝0．67，95％ CI ＝0．11～1．23，P ＜0．05）；재만성심력쇠갈（CHF）인군중，AF 조 SUA 수평고우비 AF 조（SMD＝0．27，95％ CI ＝0．01～0．52，P ＜0．05）；④AF 아형분석표명，진발성 AF 조（SMD＝0．38，95％ CI ＝0．16～0．59，P ＜0．01）、영구성 AF 조（SMD＝1．44，95％ CI ＝1．18～1．70，P ＜0．01）적 SUA 수평현저고우비 AF 조；이지속성 AF 조여대조조간 SUA 차이무통계학의의（SMD＝1．04，95％ CI ＝0．27～1．82，P ＞0．05）；진발성 AF 조적 SUA 수평현저저우영구성 AF 조（SMD＝－1．19，95％ CI ＝－1．97～－0．42，P ＜0．01）。결론불론재보통인군환시고혈압、CHF 인군중，AF 환자적 SUA 수평균명현승고。현유증거표명고뇨산혈증가능여 AF 발병유관。
ABSTRACT:Objective To systematicall evaluate whether serum uric acid (SUA) is correlated with atrial fibrillation(AF).Methods The search involved case-control studies and cohort studies on the relationship between SUA and the risk of AF in the databases such as PubMed,EMbase,VIP,CNKI,and Wanfang from their establishment to Sep.30,2014.The references of the studies were also searched manually.Assessment and data extraction were conducted by two experienced reviewers independently. Then,meta-analysis was performed using Statav 12.0 software.Results 17 case-control studies and 7 cohort studies including 174 454 patients were identified.Meta-analysis showed that SUA level in AF group was significantly higher than that in control group (SMD=0.64,95% CI=0.47-0.82,P <0.01),especially in the hypertension population and chronic heart failure(CHF)population (SMD=0.67,95% CI =0.11-1.23,P <0.05 and SMD=0.27,95% CI =0.01-0.52,P <0.05,respectively).In addition, hyperuricemia was highly correlated with AF incidence (RR = 1.65,95% CI = 1.26-2.16,P < 0.01).In terms of subgroup analysis,SUA level in the paroxysmal AF and permanent AF were remarkably higher than that in non-AF control group (SMD= 0.38,95% CI = 0.16-0.59,P < 0.01 and SMD = 1.44,95% CI = 1.18-1.70,P < 0.01, respectively),whereas there was no significant difference between persistent AF and non-AF control group (SMD=1.04,95% CI =0.27-1.82,P >0.05).Furthermore,SUA level in the paroxysmal AF was significantly lower than in permanent AF (SMD=-1.19,95% CI =-1.97 to -0.42,P <0.01).Conclusion SUA level is prominently higher in the AF patients in the general population,hypertension population or CHF population,suggesting that SUA level is associated with AF.
