血清尿酸水平与老年脑梗死患者颅内外动脉粥样硬化性狭窄的关系研究

背景血清尿酸(UA)水平升高可导致内皮细胞功能及血小板功能下降等而引起血栓形成,颅内外动脉粥样硬化性狭窄是脑梗死的主要病理基础,但血清UA水平对颅内外动脉粥样硬化性狭窄的影响目前尚不清楚。目的探讨血清UA水平与老年脑梗死患者颅内外动脉粥样硬化性狭窄的关系。方法选取2017年6月—2019年4月靖江市人民医院收治的老年脑梗死患者198例,根据颅脑CT血管造影检查结果分为对照组(非脑动脉粥样硬化性狭窄,n=58)和研究组(颅内/颅外动脉粥样硬化性狭窄,n=140);另根据动脉粥样硬化性狭窄程度将140例颅内外动脉粥样硬化性狭窄患者分为轻度56例、中度65例和重度19例。比较对照组和研究组患者性别、年龄、合并症、吸烟史及实验室检查指标;比较轻、中、重度颅内外动脉狭窄患者血清UA水平;老年脑梗死患者颅内外动脉粥样硬化性狭窄的影响因素分析采用多因素Logistic回归分析。结果研究组患者年龄大于对照组,高血压发生率、糖尿病发生率及总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、UA水平高于对照组(P<0.05)。多因素Logistic回归分析结果显示,高血压〔OR=4.536,95%CI(1.227,16.765)〕、糖尿病〔OR=7.243,95%CI(1.283,40.882)〕、LDL-C≥4.00 mmol/L〔OR=3.511,95%CI(1.994,12.407)〕、血清UA水平≥400μmol/L〔OR=3.762,95%CI(1.032,13.717)〕是老年脑梗死患者颅内外动脉粥样硬化性狭窄的独立危险因素(P<0.05)。中、重度颅内外动脉粥样硬化性狭窄患者血清UA水平高于轻度者,重度颅内外动脉粥样硬化性狭窄患者血清UA水平高于中度者(P<0.05)。结论血清UA水平≥400μmol/L是老年脑梗死患者颅内外动脉粥样硬化性狭窄的独立危险因素,且血清UA水平随老年脑梗死患者颅内外动脉粥样硬化性狭窄程度加重而升高。

Relationship between Serum Uric Acid Level and Intracranial/Extracranial Atherosclerotic Stenosis in Elderly Patients with Cerebral Infarction

Background Elevation of serum uric acid(UA)level may lead to thrombogenesis through decreasing endothelial cell function and platelet function,intracranial/extracranial atherosclerotic stenosis is the main pathological basis of cerebral infarction,however impact of serum UA level on intracranial/extracranial atherosclerotic stenosis is not very clear at present.Objective To investigate the relationship between serum UA level and intracranial/extracranial atherosclerotic stenosis in elderly patients with cerebral infarction.Methods A total of 198 elderly patients with cerebral infarction were selected in the People's Hospital of Jingjiang from June 2017 to April 2019,and they were divided into control group(without atherosclerotic stenosis of cerebral artery,n=58)and study group(with intracranial/external atherosclerotic stenosis,n=140);patients in study group were divided into mild stenosis(n=56),moderate stenosis(n=65)and severe stenosis(n=19)according to degree of atherosclerotic stenosis.Gender,age,merged diseases,smoking history and laboratory examination results were compared between control group and study group;serum UA level was compared in patient with different degree of atherosclerotic stenosis;multivariate Logistic regression analysis was used to analyze the influencing factors of intracranial/extracranial atherosclerotic stenosis in elderly patients with cerebral infarction.Results Age in study group was older than that in control group,incidence of hypertension and diabetes mellitus,as well as TC,LDL-C and UA in study group were statistically significantly higher than those in control group(P<0.05).Multivariate Logistic results showed that,hypertension〔OR=4.536,95%CI(1.227,16.765)〕,diabetes mellitus〔OR=7.243,95%CI(1.283,40.882)〕,LDL-C≥4.00 mmol/L〔OR=3.511,95%CI(1.994,12.407)〕and serum UA level≥400μmol/L〔OR=3.762,95%CI(1.032,13.717)〕were risk factors of intracranial/extracranial atherosclerotic stenosis in elderly patients with cerebral infarction(P<0.05).Serum UA level in patients with moderate and severe intracranial/extracranial atherosclerotic stenosis was statistically significantly higher than that in patients with mild intracranial/extracranial atherosclerotic stenosis,respectively,meanwhile serum UA level of in patients with severe intracranial/extracranial atherosclerotic stenosis was statistically significantly higher than that in patients with moderate intracranial/extracranial atherosclerotic stenosis(P<0.05).Conclusion Serum UA level≥400μmol/L is one of independent risk factors of intracranial/extracranial atherosclerotic stenosis in elderly patients with cerebral infarction,and the serum UA level increases as intracranial/extracranial atherosclerotic stenosis degree exacerbates in elderly patients with cerebral infarction.