临床荟萃 ›› 2024, Vol. 39 ›› Issue (3): 216-221.doi: 10.3969/j.issn.1004-583X.2024.03.003

• 论著 • 上一篇    下一篇

血尿酸与首次急性缺血性脑卒中患者TOAST分型及预后的相关性

宋梦姣1a, 王睿琪1a, 曹灿2, 程光森1b, 刘羽1b, 李忠亮1b, 杨建豪1b()   

  1. 1.珠海市人民医院(暨南大学珠海临床医学院) a.药学部;b.脑血管病科,广东 珠海 519000
    2.珠海市金湾区平沙社区卫生服务中心,广东 珠海 519000
  • 收稿日期:2023-12-15 出版日期:2024-03-20 发布日期:2024-06-12
  • 通讯作者: 杨建豪 E-mail:670166791@qq.com
  • 基金资助:
    国家自然科学基金(青年科学基金项目)——肝癌中钙调磷酸酶RCAN2/FGFR4调节免疫浸润逆转仑伐替尼治疗耐药的机制研究(82303902);2023年PSM广东药学科普研究基金(先声基金)项目——探索新媒体模式在脑卒中患者用药科普中的应用(2023KP54);珠海市科技计划医疗卫生项目(一般项目)——药学服务在缺血性脑卒中患者二级预防中的作用评价及其管理模式的研究(ZH2202200042HJL);珠海市医学科研基金项目——丁苯酞对颈动脉支架置入术患者围手术期并发症的影响(ZH24013310210073PWC)

Correlation between serum uric acid with TOAST classification and prognosis in patients with first-onset acute ischemic stroke

Song Mengjiao1a, Wang Ruiqi1a, Cao Can2, Cheng Guangsen1b, Liu Yu1b, Li Zhongliang1b, Yang Jianhao1b()   

  1. 1a. Department of Pharmacy; b. Department of Cerebrovascular Disease, Zhuhai People’s Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai 519000, China
    2. Zhuhai Jinwan District Pingsha Community Health Service Center, Zhuhai 519000, China
  • Received:2023-12-15 Online:2024-03-20 Published:2024-06-12
  • Contact: Yang Jianhao E-mail:670166791@qq.com

摘要:

目的 探究血尿酸与首次急性缺血性脑卒中患者类肝素药物治疗急性缺血性脑卒中试验(trial of org 10172 in acute stroke treatment,TOAST)分型和长期预后的相关性。方法 选取2020年10月至2021年10月于珠海市人民医院住院治疗的首次急性缺血性脑卒中患者199例。依据血尿酸水平将患者分为4组[≤280 μmol/L组(n=50)、280.1~331 μmol/L组(n=50)、331.1~398 μmol/L组(n=50)和>398 μmol/L组(n=49)],分析各组血尿酸与TOAST分型等指标的相关性。采用改良Rankin量表评价患者发病3个月后的预后情况,0~2分为预后良好组(n=157),3~6分为预后不良组(n=42),比较两组预后与血尿酸等指标的相关性。结果 不同血尿酸组TOAST分型差异无统计学意义(P>0.05),性别、血脂异常占比和血同型半胱氨酸水平差异均有统计学意义(P<0.05);经有序多分类Logistic回归分析,男性(OR=2.984,95%CI:1.603~5.553,P=0.001)和血脂异常(OR=2.600,95%CI:1.442~4.686,P=0.001)均与高血尿酸水平有关。不同预后组血尿酸水平差异无统计学意义(P>0.05),基线NIHSS评分和基线Barthel指数差异有统计学意义(P<0.01),经二元Logistic回归分析,较低基线Barthel指数是患者预后不良的危险因素(OR=0.905,95%CI:0.867~0.944,P=0.000)。结论 血尿酸与首次急性缺血性脑卒中患者TOAST分型和预后未显示出相关性,但是男性和血脂异常均与高血尿酸有关,且较低基线Barthel指数提示预后不良。

关键词: 缺血性卒中, 血尿酸, TOAST分型, 预后

Abstract:

Objective To explore the correlation between serum uric acid (SUA) levels with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification and long-term prognosis in patients with first-onset acute ischemic stroke (AIS). Methods A total of 199 patients with first-onset AIS who were hospitalized at Zhuhai People's Hospital from October 2020 to October 2021 were enrolled. They were divided into 4 groups based on SUA levels, which consisted of ≤280 μmol/L group (n=50), 280.1-331 μmol/L group (n=50), 331.1-398 μmol/L group (n=50) and >398 μmol/L group (n=49), and the correlation between SUA levels and TOAST classification was analyzed. The modified Rankin scale was used to evaluate the prognosis of patients after 3 months of onset, and the patients were assigned into good prognosis group (modified Rankin scale: 0-2 points, n=157) and poor prognosis group (modified Rankin scale: 3-6 points, n=42). The correlation between SUA levels and the prognosis of the two groups was compared. Results There was no statistically significant difference in TOAST classification among different SUA groups (P>0.05), but there were overall statistically significant differences in gender, proportion of dyslipidemia, and blood homocysteine levels (P<0.05). The ordinal multinomial logistic regression analysis indicated both male (OR=2.984, 95%CI: 1.603-5.553, P=0.001) and dyslipidemia (OR=2.600, 95%CI: 1.442-4.686, P=0.001) were associated with high SUA levels. There was no statistically significant difference in SUA levels between good prognosis group and poor prognosis group (P>0.05), but there was a statistically significant difference in baseline scores of National Institute of Health Stroke Scale (NIHSS) and Barthel Index (BI)(P<0.01). Binary logistic regression analysis showed a lower baseline score of BI was a risk factor for poor prognosis in the patients (OR=0.905, 95%CI: 0.867-0.944, P=0.000). Conclusion There was no correlation between SUA levels with TOAST classification and prognosis in patients with first-onset AIS, but both male and dyslipidemia were associated with high SUA levels, and a lower baseline score of BI indicated poor prognosis.

Key words: ischemic stroke, serum uric acid, TOAST classification, prognosis

中图分类号: