CAJ | 학술논문

目的：探讨血清尿酸水平（ SUA）与急性缺血性脑卒中（ AIS）患者不良预后的相关性。方法连续收集2011年1月至2013年9月兴宁市人民医院住院诊断为AIS患者463例。测量其入院SUA水平，分析SUA与在随访期30 d，3、6、12个月时使用改良 Rankin量表（ mRS）所评价的预后功能之间的相关性。mRS 评分为0～1时视为预后良好。结果研究共纳入463例患者，52%为男性，平均年龄68岁。入院时SUA平均水平为（6.1±3.7）mg/dl。与高SUA水平患者相比，SUA≤4.5 mg/dl患者的30 d良好预后的比例更高（ P=0.004）。尚不能认为SUA与30 d病死率或功能不良相关。同时，尚不能认为与卒中后3、6、12个月不良预后相关。然而，在校正年龄、性别、卒中类型和严重程度（NIHSS <9）、卒中发作后时间、血清肌酐、高血压、糖尿病和吸烟后，SUA 水平≤4.5 mg/dl与短期良好预后呈正相关（比值比=1.76，95%可信区间为1.05～2.95，阴性预测值=81.1%），而尚不能认为与随访3、6或12个月的预后相关。与高水平SUA患者相比，SUA≤4.5 mg/dl患者往往年龄<55岁、多为女性、轻度中风、血清肌酐水平正常、很少患高血压。尚不能认为从卒中发作到入院的时间与AIS 严重程度或SUA水平相关。结论低SUA水平与短期良好预后相关， SUA是脑梗死程度的指标，而不是卒中预后的独立危险因素。
목적：탐토혈청뇨산수평（ SUA）여급성결혈성뇌졸중（ AIS）환자불량예후적상관성。방법련속수집2011년1월지2013년9월흥저시인민의원주원진단위AIS환자463례。측량기입원SUA수평，분석SUA여재수방기30 d，3、6、12개월시사용개량 Rankin량표（ mRS）소평개적예후공능지간적상관성。mRS 평분위0～1시시위예후량호。결과연구공납입463례환자，52%위남성，평균년령68세。입원시SUA평균수평위（6.1±3.7）mg/dl。여고SUA수평환자상비，SUA≤4.5 mg/dl환자적30 d량호예후적비례경고（ P=0.004）。상불능인위SUA여30 d병사솔혹공능불량상관。동시，상불능인위여졸중후3、6、12개월불량예후상관。연이，재교정년령、성별、졸중류형화엄중정도（NIHSS <9）、졸중발작후시간、혈청기항、고혈압、당뇨병화흡연후，SUA 수평≤4.5 mg/dl여단기량호예후정정상관（비치비=1.76，95%가신구간위1.05～2.95，음성예측치=81.1%），이상불능인위여수방3、6혹12개월적예후상관。여고수평SUA환자상비，SUA≤4.5 mg/dl환자왕왕년령<55세、다위녀성、경도중풍、혈청기항수평정상、흔소환고혈압。상불능인위종졸중발작도입원적시간여AIS 엄중정도혹SUA수평상관。결론저SUA수평여단기량호예후상관， SUA시뇌경사정도적지표，이불시졸중예후적독립위험인소。
Objective To investigate the relationship between serum uric acid( SUA)and poor prognosis in patients with a-cute ischemic stroke(AIS). Methods From Jan 2011 to Sep 2013,463 patients(52% men,mean age 68 years)with AIS ad-mitted to Xingning people’s hospital were selected,who had SUA measurements at hospital presentation. Multivariate models were constructed to analyze the association of SUA with functional outcome as assessed by the modified Rankin scale( mRS)at 30 day,3,6 and 12 month follow-up. A mRS 0-1 was regarded as a very good outcome. Results Mean SUA concentration at hospital arrival was(6. 1 ± 3. 7)mg/dl. Compared with cases with higher SUA levels at hospital admission,patients with ≤4. 5 mg/dl had more cases of a very good 30-day outcome(30. 5% vs 18. 9%,P=0. 004). SUA was not associated with mortal-ity or functional dependence(mRS >2)at 30 days,or with any outcome measure at 3,6 or 12 months post stroke. After adjust-ment for age,gender,stroke type and severity(NIHSS<9),time since event onset,serum creatinine,hypertension,diabetes and smoking,a SUA ≤4. 5 mg/dl was positively associated with a very good short-term out-come(odds ratio:1. 76,95% confi-dence interval:1. 05-2. 95;negative predictive value:81. 1%),but not at 3,6 or 12 months of follow-up. Compared with ca-ses with higher levels,patients with SUA ≤4. 5 mg/dl were more frequently younger than 55 years,women,with mild strokes, with normal serum creatinine and fewer had hypertension. The time since event on-set to hospital arrival was not significantly as-sociated with AIS severity or SUA levels;nevertheless,a non significant tendency was observed for patients with severe strokes and high SUA levels arriving in <24 h. Conclusion Low SUA concentration is correlated with good short-term outcome. SUA is a marker of the magnitude of the cerebral infarction,but not an independent predictor of stroke out-come.