急性心衰患者尿酸水平对心衰易损期预后的影响

何小龙; 罗晓宇; 郭志念; 胡华娟; 陈运龙; 成小凤; 李平; 何永铭; 王江

doi:10.16016/j.2097-0927.202201017

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急性心衰患者尿酸水平对心衰易损期预后的影响

临床医学 | 更新时间：2026-01-09

- 急性心衰患者尿酸水平对心衰易损期预后的影响
- Effects of uric acid level on prognosis of heart failure vulnerable stage in patients with acute heart failure
- 陆军军医大学学报 2022年44卷第8期页码：812-817
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院心血管内科，全军心血管病研究所
- 作者简介：
  
  [王江，E-mail: 1530579054@qq.com WANG Jiang, E-mail: 1530579054@qq.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202201017
  中图分类号： R181.32;R446.112;R541.6
- 收稿：2022-01-04，
  
  修回：2022-01-27，
  
  纸质出版：2022-04-30
- 稿件说明：
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何小龙, 罗晓宇, 郭志念, 等. 急性心衰患者尿酸水平对心衰易损期预后的影响[J]. 陆军军医大学学报, 2022,44(8):812-817.

Xiaolong HE, Xiaoyu LUO, Zhinian GUO, et al. Effects of uric acid level on prognosis of heart failure vulnerable stage in patients with acute heart failure[J]. Journal of Army Medical University, 2022, 44(8): 812-817.
何小龙, 罗晓宇, 郭志念, 等. 急性心衰患者尿酸水平对心衰易损期预后的影响[J]. 陆军军医大学学报, 2022,44(8):812-817. DOI： 10.16016/j.2097-0927.202201017.

Xiaolong HE, Xiaoyu LUO, Zhinian GUO, et al. Effects of uric acid level on prognosis of heart failure vulnerable stage in patients with acute heart failure[J]. Journal of Army Medical University, 2022, 44(8): 812-817. DOI： 10.16016/j.2097-0927.202201017.

摘要

目的

探讨急性心力衰竭患者(acute heart failure，AHF)入院后不同血清尿酸(serum uric acid，SUA)水平对出院后心衰易损期心脏全因死亡以及心衰再入院(major adverse cardiac events，MACE)事件发生的影响。

方法

收集陆军军医大学第二附属医院心血管内科自2019年10月至2021年7月收治AHF患者的临床资料，随访3个月，根据患者出院后易损期内是否发生MACE事件分为事件组与对照组，比较两组患者基线数据之间的差异，并对可能影响易损期MACE事件的因素进行多因素Logistic回归分析，探讨高SUA与AHF患者心衰易损期内预后的相关性。

结果

共纳入539例AHF住院患者，事件组194例(35.9%)，对照组345例(64.1%)。其中事件组高SUA 175例(90.3%)，正常SUA 19例(9.7%)，两者差异有统计学意义(

＜0.05)。与对照组比较，事件组的SUA、D-二聚体、尿素氮、脑钠肽(BNP)水平和NYHA心功能分级、左心房前后径、左心室横径水平更高(

＜0.05)，而体质量指数(BMI)、平均动脉压、血钠、白蛋白、总胆固醇(TC)水平更低(

＜0.05)。Logistic回归分析显示，高SUA(

: 3.419，95%

: 1.805~6.477

＜0.05)是易损期MACE事件的独立危险因素。

结论

高SUA的AHF患者出院后易损期内MACE事件发生率高，有助于评估AHF患者易损期预后。

Abstract

Objective

To investigate the relationship between different serum uric acid (SUA) levels after admission and the incidence of cardiac major adverse cardiac events (MACE) in the vulnerable stage of heart failure after discharge in patients with acute heart failure (AHF).

Methods

Clinical data of AHF patients admitted to our department from October 2019 to July 2021 were collected

and all of them were followed up for 3 months. According to whether MACE events occurred during the vulnerable period after discharge

the patients were divided into event group and control group. The differences of the baseline data were compared between the 2 groups

and the factors that may affect the MACE events in the vulnerable period were analyzed with multivariate logistic regression analysis. The correlation between high SUA level and prognosis in the vulnerable period was analyzed.

Results

A total of 539 hospitalized AHF patients were included in this study

including 194 (35.9%) in the event group and 345 (64.1%) in the control group. In the event group

175 cases (90.3%) had high SUA level and 19 cases (9.7%) had normal SUA level (

0.05). The event group had higher levels of SUA

D-dimer

blood urea nitrogen

brain natriuretic peptide (BNP) and NYHA cardiac function class

left atrial anteroposterior diameter

and left ventricular transverse diameter (

0.05)

while lower body mass index (BMI)

mean arterial pressure

serum sodium

albumin

and total cholesterol (TC) (

0.05). Logistic regression analysis showed that high SUA (

=3.419

95%

: 1.805~6.477

0.05) was an independent risk factor for MACE events in the vulnerable period of AHF patients.

Conclusion

The AHF patients with high SUA level are prone to the occurrence of MACE events in the vulnerable period after discharge. SUA is a helpful indicator for evaluating the prognosis of AHF patients in the vulnerable period.

关键词

Keywords

references

中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789. DOI: 10.3760/cma.j.issn.0253-3758.2018.10.004.

Heart Failure Group of Chinese Society of Cardiology of Chinese Medical Association, Chinese Heart FailureAssociation of Chinese Medical Doctor Association, Editorial Board of Chinese Journal of Cardiology. Chinese heart failure diagnosis and treatment guidelines 2018[J]. Chin J Cardiol, 2018, 46(10): 760-789. DOI: 10.3760/cma.j.issn.0253-3758.2018.10.004.

SWEDBERG K, KOMAJDA M, BÖHM M, et al . Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study[J ] . Lancet, 2010, 376(9744): 875-885. DOI: 10.1016/S0140-6736(10)61198-1.

YUSUF S, PFEFFER M A, SWEDBERG K. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: The CHARM-Preserved Trial[J]. Lancet, 2003, 362(9386): 777-781. DOI: 10.1016/S0140-6736(03)14285-7.

王立群. 心力衰竭易损期[J]. 中华心脏与心律电子杂志, 2017, 5(2): 81-82.

WANG L Q. Vulnerable period of heart failure[J]. Chin J Heart Heart Rhythm Electr Ed, 2017, 5(2): 81-82.

濮存莹, 廖深根, 郑旭辉, 等. 高尿酸血症预测急性心力衰竭患者长期预后的临床价值[J]. 临床心血管病杂志, 2019, 35(6): 521-525. DOI: 10.13201/j.issn.1001-1439.2019.06.009.

PU C Y, LIAO S G, ZHENG X H, et al . The long-term predictive value of hyperuricemia in acute heart failure[J ] . J Clin Cardiol, 2019, 35(6): 521-525. DOI: 10.13201/j.issn.1001-1439.2019.06.009.

吴炎, 王亚年, 蒲红. 血清尿酸水平与急性心力衰竭患者近2年预后的关系[J]. 中国循证心血管医学杂志, 2020, 12(9): 1094-1097. DOI: 10.3969/j.issn.1674-4055.2020.09.18.

WU Y, WANG Y N, PU H. Relationship between level of serum uric acid and prognosis in patients with acute heart failure in recent 2 years[J]. Chin J Evid Based Cardiovasc Med, 2020, 12(9): 1094-1097. DOI: 10.3969/j.issn.1674-4055.2020.09.18.

石小溪, 赵宇飞, 陈涛, 等. 左西孟旦联合重组人B型利钠肽治疗老年难治性心力衰竭患者的短期疗效[J]. 中华心力衰竭和心肌病杂志, 2021, 5(3): 157-161. DOI: 10.3760/cma.j.cn101460-20200916-00096.

SHI X X, ZHAO Y F, CHEN T, et al . Short-term efficacy of levosimendan combined with recombinant human brain natriuretic peptide in elderly patients with refractory heart failure[J ] . Chin J Heart Fail Cardiomyopathy, 2021, 5(3): 157-161. DOI: 10.3760/cma.j.cn101460-20200916-00096.

MCDONAGH T A, METRA M, ADAMO M, et al . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J ] . Eur Heart J, 2021, 42(36): 3599-3726. DOI: 10.1093/eurheartj/ehab368.

冯高科, 徐林. 《高尿酸血症合并心血管高风险患者诊断和治疗的专家共识: 2021年更新版》更新要点解读[J]. 实用心脑肺血管病杂志, 2021, 29(5): 1-7. DOI: 10.12114/j.issn.1008-5971.2021.00.083.

FENG G K, XU L. Interpretation of the Expert Consensus for the Diagnosis and Treatment of Patient with Hyperuricemia and High Cardiovascular Risk: 2021 Update[J]. Pract J Cardiac Cereb Pneumal Vasc Dis, 2021, 29(5): 1-7. DOI: 10.12114/j.issn.1008-5971.2021.00.083.

GREENE S J, FONAROW G C, VADUGANATHAN M, et al . The vulnerable phase after hospitalization for heart failure[J ] . Nat Rev Cardiol, 2015, 12(4): 220-229. DOI: 10.1038/nrcardio.2015.14.

AMIN A, CHITSAZAN M, SHIUKHI AHMAD ABAD F, et al . On admission serum sodium and uric acid levels predict 30 day rehospitalization or death in patients with acute decompensated heart failure[J ] . ESC Heart Fail, 2017, 4(2): 162-168. DOI: 10.1002/ehf2.12135.

ZAPATERO A, BARBA R, GONZALEZ N, et al . Influence of obesity and malnutrition on acute heart failure[J ] . Revista Española De Cardiol Engl Ed, 2012, 65(5): 421-426. DOI: 10.1016/j.rec.2011.09.014.

SESSO H D, STAMPFER M J, ROSNER B, et al . Systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in Men[J ] . Hypertension, 2000, 36(5): 801-807. DOI: 10.1161/01.hyp.36.5.801.

BURSTEIN B, TABI M, BARSNESS G W, et al . Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock[J ] . Crit Care, 2020, 24(1): 513. DOI: 10.1186/s13054-020-03217-6.

TORRES D, CUTTITTA F, PATERNA S, et al . Bed-side inferior vena cava diameter and mean arterial pressure predict long-term mortality in hospitalized patients with heart failure: 36 months of follow-up[J ] . Eur J Intern Med, 2016, 28: 80-84. DOI: 10.1016/j.ejim.2015.11.029.

LIU M H, CHEN X H, ZHANG S Z, et al . Long-term visit-to-visit mean arterial pressure variability and the risk of heart failure and all-cause mortality[J ] . Front Cardiovasc Med, 2021, 8: 665117. DOI: 10.3389/fcvm.2021.665117.

MAZZALI M, KANBAY M, SEGAL M S, et al . Uric acid and hypertension: cause or effect?[J ] . Curr Rheumatol Rep, 2010, 12(2): 108-117. DOI: 10.1007/s11926-010-0094-1.

WANG J, QIN T Q, CHEN J R, et al . Hyperuricemia and risk of incident hypertension: a systematic review and meta-analysis of observational studies[J ] . PLoS One, 2014, 9(12): e114259. DOI: 10.1371/journal.pone.0114259.

KIM S Y, GUEVARA J P, KIM K M, et al . Hyperuricemia and risk of stroke: a systematic review and met a-analysis[J ] . Arthritis Rheum, 2009, 61(7): 885-892. DOI: 10.1002/art.24612.

桂巧巧, 王永红, 张明军, 等. 重庆市成人血尿酸水平与代谢综合征相关因素分析[J]. 第三军医大学学报, 2012, 34(10): 995-998. DOI: 10.16016/j.1000-5404.2012.10.002.

GUI Q Q, WANG Y H, ZHANG M J, et al . Correlation of serum uric acid level and metabolic syndrome in Chongqing adults[J ] . J Third Mil Med Univ, 2012, 34(10): 995-998. DOI: 10.16016/j.1000-5404.2012.10.002.

PURNIMA S, EL-AAL B G A. Serum uric acid as prognostic marker of coronary heart disease (CHD)[J]. Clin Investig Arterioscler, 2016, 28(5): 216-224. DOI: 10.1016/j.arteri.2016.05.006.

XU Y L, ZHU J Y, GAO L, et al . Hyperuricemia as an independent predictor of vascular complications and mortality in type 2 diabetes patients: a meta-analysis[J ] . PLoS One, 2013, 8(10): e78206. DOI: 10.1371/journal.pone.0078206.

EKUNDAYO O J, DELL'ITALIA L J, SANDERS P W, et al . Association between hyperuricemia and incident heart failure among older adults: a propensity-matched study[J ] . Int J Cardiol, 2010, 142(3): 279-287. DOI: 10.1016/j.ijcard.2009.01.010.

MIAO L N, GUO M, PAN D, et al . Serum uric acid and risk of chronic heart failure: a systematic review and meta-analysis[J ] . Front Med (Lausanne), 2021, 8: 785327. DOI: 10.3389/fmed.2021.785327.

HUANG G, QIN J, DENG X J, et al . Prognostic value of serum uric acid in patients with acute heart failure: a meta-analysis[J ] . Medicine, 2019, 98(8): e14525. DOI: 10.1097/MD.0000000000014525.

LLAUGER L, JACOB J, MIRÓ Ò. Renal function and acute heart failure outcome[J]. Med Clin (Barc), 2018, 151(7): 281-290. DOI: 10.1016/j.medcli.2018.05.010.

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