[1]吴樱,柯组辉,黄英杰,等.高尿酸血症与风湿性主动脉瓣置换后不良事件的关系:>40岁患者分析[J].南方医科大学学报,2017,(07):943.
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高尿酸血症与风湿性主动脉瓣置换后不良事件的关系:>40岁患者分析()
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《南方医科大学学报》[ISSN:1673-4254/CN:44-1627/R]

卷:
期数:
2017年07期
页码:
943
栏目:
出版日期:
2017-07-20

文章信息/Info

Title:
Relationship between hyperuricemia and adverse events in patients aged 40 years or older receiving rheumatic aortic valve replacement
作者:
吴樱柯组辉黄英杰黄洁棱余丹青魏学标陈晓兰
关键词:
高尿酸血症风湿性心脏病瓣膜置换手术
Keywords:
hyperuricemia rheumatic heart disease valve replacement
摘要:
目的探讨高尿酸血症对中老年风湿性主动脉瓣置换后患者的院内及1年不良事件的预测价值。方法连续性入选2009 年3月~2013年7月间在我院诊断为风湿性主动脉瓣疾病并接受外科主动脉瓣瓣膜置换手术中老年患者(>40岁),根据血清尿 酸水平,分为高尿酸血症组和血尿酸正常组两组。比较两组临床资料的差异,多因素分析评估高尿酸血症与不良事件发生的关 系。结果共有632名患者入选,分为高尿酸血症组(n=381)和血尿酸正常组(n=251)。高尿酸血症组院内死亡率显著高于血尿 酸正常组(7.6% vs 2.0%,P=0.002)。血尿酸与肾小球滤过率呈负相关(r=-0.421,P<0.001),与C反应蛋白呈正相关(r=0.093,P= 0.025)。多因素分析显示,经校正影响预后的混杂因素,包括年龄、NYHA心功能III-IV级和术后急性肾损伤后,高尿酸血症与 院内死亡率(OR=3.07,95% CI:1.13,8.37,P=0.028)和1 年死亡率(HR=3.14,95% CI:1.30,7.62,P=0.011)独立相关。 Kaplan-Meier分析显示,高尿酸血症组患者手术后1年死亡率累积率较高(Log-rank=11.73,P=0.001)。结论高尿酸血症是中 老年风湿性主动脉瓣置换后患者院内死亡及1年死亡的独立预测因子。
Abstract:
Objective To explore the prognostic value of hyperuricemia for adverse events in patients >40 years old receiving valve replacement surgery for rheumatic aortic valve disease. Methods Consecutive middle-aged and elderly patients receiving aortic valve replacement surgery for rheumatic aortic valve disease between March, 2009 and July, 2013 were recruited in this study. The patients were divided into hyperuricemic group and normouricemic group based on their serum levels of uric acid, and the clinical data and adverse events within 1 year after the surgery were compared between the 2 groups. Results A total of 632 consecutive patients were recruited, including 381 patients with hyperuricemia and 251 with normouricemia. The in-hospital mortality rate was significantly higher in hyperuricemic group than in normouricemic group (7.6% vs 2.0% , P=0.002). Serum uric acid levels were negatively correlated with eGFR (r=-0.421, P<0.001) and positively correlated with C-reactive protein level (r=0.093, P=0.025). Multivariate analysis showed that hyperuricemia was independently associated with the in-hospital mortality (OR=3.07, 95%CI: 1.13-8.37, P=0.028) and mortality at 1 year after the surgery (HR=3.14, 95% CI: 1.30-7.62, P=0.011) after adjusting for potential risk factors including age, NYHA III-IV and postoperative acute kidney injury (AKI). Kaplan-Meier analysis showed that the cumulative rate of 1-year mortality after surgery was significantly higher in patients with hyperuricemia (Log-rank=11.73, P=0.001). Conclusion Hyperuricemia is a predictor of in-hospital and one-year mortality in middle-aged and elderly patients following aortic valve replacement surgery for rheumatic aortic valve disease.

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更新日期/Last Update: 1900-01-01