The correlation between serum uric acid and neurological impairment and prognosis in patients with acute cerebral infarction
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摘要: 目的 分析血清尿酸(SUA)水平与急性脑梗死患者神经功能损伤及其预后的相关性。方法 选择2020年1月-2021年6月期间我院收治的138例急性脑梗死患者作为观察组，选择同时期来我院体检健康者100例作为对照组。比较两组的一般临床资料，检测SUA、肌酐、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)水平，根据《脑卒中患者临床神经功能缺损程度评分标准》(CSS)评定方法，评价观察组的神经功能受损情况并分为3个亚组，即轻度组50例，中度组41例，重度组47例，比较观察组的3个亚组与对照组SUA水平；出院3个月后，采用改良Rankin量表评价患者的预后水平，单因素及多因素logistic回归分析影响急性脑梗死患者预后的因素。结果 观察组与对照组的性别、年龄、BMI及吸烟史、饮酒史、高血脂史、糖尿病史的比例进行比较，均差异无统计学意义(均P>0.05)；观察组高血压史的比例高于对照组(67.39% vs.31.00%)，SUA水平高于对照组(422.18±55.34 vs.361.12±45.32)，均差异有统计学意义(P< 0.01)；SUA水平：对照组 < 轻度组 < 中度组 < 重度组，4组比较，差异有统计学意义(均P< 0.05)；SUA水平与CSS评分呈正相关(r=0.416，P< 0.05)；高龄、高血压、高SUA及CSS评分高均为影响急性脑梗死患者预后的独立危险因素。结论 SUA水平与急性脑梗死患者神经功能缺损程度呈正相关，SUA水平升高是急性脑梗死患者预后独立预测因子。Abstract: Objective To analyze the correlation between the levels of serum uric acid and neurological impairment and prognosis in patients with acute cerebral infarction.Methods One hundred and thirty-eight patients with acute cerebral infarction admitted to our hospital from January 2020 to December 2020 were selected as the observation group, and 100 healthy patients who came to our hospital for physical examination during the same period were selected as the control group. Compare general clinical data between the two groups. Serum levels of uric acid, creatinine, HDL-C and LDL-C were detected. According to the Scoring Standard of Clinical Neurological Deficit degree in Stroke patients(CSS), the neurological impairment in the observation group was evaluated and divided into three subgroups, namely 50 cases in the mild group, 41 cases in the moderate group and 47 cases in the severe group. The levels of serum uric acid was compared between the observation group and the control group. Three months after discharge, the improved Rankin scale was used to evaluate the prognostic level of patients. Univariate and multivariate logistic regression were used to analyze the influencing factors of the prognosis of patients with acute cerebral infarction.Results There were no significant difference in gender, age, BMI, history of smoking, drinking, hyperlipidemia and diabetes between the observation group and the control group(allP>0.05). In the observation group, the proportion of hypertension history was higher than that in the control group(67.39% vs. 31.00%,P< 0.01), and the level of uric acid was significantly higher than that in the control group(422.18±55.34 vs. 361.12±45.32,P< 0.01). The levels of uric acid in the control group < mild group < moderate group < severe group(allP< 0.05). Old age, hypertension, high uric acid, and high CSS score were all independent risk factors of the prognosis of patients with acute cerebral infarction. The levels of serum uric acid was positively correlated with CSS score(r=0.416,P< 0.05).Conclusion The levels of serum uric acid was positively correlated with the degree of neurological impairment in patients with acute cerebral infarction. The levels of serum uric acid is an independent predictor of prognosis in patients with acute cerebral infarction.
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Key words:
- serum uric acid /
- acute cerebral infarction /
- neurological deficit /
- prognosis
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表 1 两组患者的一般资料比较
例(%) 组别 例数 性别/例 年龄/岁 BMI 吸烟史 饮酒史 高血压史 高血脂史 糖尿病史 SUA/
(μmol·L-1)男 女 观察组 138 77 61 58.25±6.46 22.47± 1.13 58(42.03) 21(15.22) 93(67.39) 44(31.88) 39(28.26) 422.18±55.34 对照组 100 54 46 57.36± 6.12 22.60±1.08 40(40.00) 14(14.00) 31(31.00) 23(23.00) 25(25.00) 361.12± 45.32 t/χ2 0.782 1.082 0.971 0.099 0.069 30.770 2.263 0.314 9.341 P 0.379 0.249 0.336 0.758 0.776 < 0.001 0.134 0.563 < 0.001 
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表 2 不同组别CSS评分和SUA水平比较
X±S 组别 例数 CSS评分/分 SUA/(μmol·L-1) 对照组 100 361.12±45.32 轻度组 50 9.25±2.08 386.77±41.321) 中度组 41 25.38±3.122) 408.04±45.381)2) 重度组 47 40.14±4.092)3) 472.18±50.261)2)3) 与对照组比较，1)P < 0.05；与轻度组比较，2)P < 0.05；与中度组比较，3)P < 0.05。
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表 3 影响急性脑梗死患者预后的单因素分析
例(%), X±S 组别 预后较好组(85例) 预后不良组(53例) t/χ2 P 年龄/岁 52.08±4.12 68.15±5.68 17.873 < 0.001 性别 男 49(57.64) 28(52.83) 0.307 0.584 女 36(42.36) 25(47.17) BMI 22.43±1.08 22.53±1.25 0.481 0.711 吸烟 37(43.52) 21(39.62) 0.204 0.887 饮酒 13(15.29) 9(16.98) 0.069 0.983 高血压 50(58.82) 43(81.13) 7.393 0.001 高血脂 25(29.41) 19(35.85) 0.623 0.422 糖尿病 24(28.24) 15(28.30) 0 0.989 SUA/(μmol·L-1) 404.39±46.63 450.71±50.28 5.411 < 0.001 肌酐/(μmol·L-1) 93.17±18.26 95.42±16.44 0.749 0.386 HDL-C/(mmol·L-1) 1.14±0.28 1.15±0.25 0.218 0.799 LDL-C/(mmol·L-1) 2.77±0.51 2.81±0.47 0.470 0.683 CSS评分/分 29.16±3.66 47.76±4.25 26.347 < 0.001
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表 4 影响急性脑梗死患者预后的logistic多因素回归分析
危险因素 回归系数 标准误 Wald χ2 OR 95%CI P 年龄 1.324 0.727 3.317 4.124 1.374~10.046 0.003 高血压 1.039 0.655 2.516 2.825 1.076~8.128 0.034 SUA 1.267 0.548 8.012 5.346 1.481~15.038 0.015 CSS评分 1.431 0.315 20.64 4.183 1.424~12.698 0.001
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