血尿酸水平与冠状动脉薄纤维帽粥样硬化斑块的相关性研究
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摘要
目的:利用光学相干断层扫描技术(OCT)研究血尿酸水平与薄纤维帽粥样硬化斑块(TCFA)之间的相关性。方法:入选2015-01-2018-02在新疆医科大学第一附属医院心脏中心住院治疗的冠心病患者129例。所有患者均经冠状动脉造影术确诊,采用OCT测定冠状动脉粥样硬化斑块参数。采用多重线性回归的统计方法分析血清尿酸水平与TCFA的关系。结果:①基于OCT结果将129例患者分为非TCFA组(96例)和TCFA组(33例),在单因素分析中,两组患者的性别、吸烟、2型糖尿病、体质指数(BMI)、肾小球滤过率(eGFR)、尿酸、低密度脂蛋白胆固醇(LDL-C)等比较,差异有统计学意义(P<0.05);在多因素logistic回归分析中,吸烟、2型糖尿病、LDL-C、尿酸为TCFA的影响因素(分别为P=0.016、P=0.007、P=0.005、P=0.025),且为TCFA发生的预测因子,其中血尿酸是其独立危险因素(OR=1.007,95%CI:1.001～1.014,P=0.025);②根据血尿酸水平将患者分为高尿酸(>420μmol/L)组(27例)与低尿酸(<420μmol/L)组(102例),两组在纤维帽厚度、脂质弧、巨噬细胞评级、斑块破裂、血栓方面均差异有统计学意义(分别为P<0.001、P=0.002、P=0.025、P=0.007、P=0.001)。结论:TCFA的发生率与患者血尿酸水平升高独立相关,斑块不稳定与血尿酸水平有关。
Objective:The study was designed to determine the relationship between the level of serum uric acid and thin-cap fibroatheroma(TCFA) detected by optical coherence tomography(OCT).Method:A total of 129 patients were recruited from the First Affiliated Hospital of Xinjiang Medical University from January 2015 to February 2018. CHD patient was diagnosed by coronary angiography. The parameters of coronary atherosclerotic plaque were determined based on OCT.The relationship between serum uric acid level and TCFA was analyzed by multiple logistic regression analysis.Result: A total of 129 patients were divided into non-TCFA group(96 cases) and TCFA group(33 cases) based on OCT.①Univariate analyses indicated that patients with TCFA had higher body mass index,smoking,low density lipoprotein,eGFR,uric acid and diabetes compared to those with non-TCFA.In addition, after adjusting for significant confounding factors including smoking,diabetes mellitus,low density lipoprotein, serum uric acid by multivariate regression analysis, multiple logistic regression analysis showed that smoking,diabetes mellitus,low density lipoprotein, and serum uric acid were affect factors of TCFA(P=0.016,P=0.007,P=0.005,P=0.025)and predictor of plaque instability.Serum uric acid was an independent risk factor for the TCFA(OR=1.007,95%CI:1.001-1.014,P=0.025).② Those patients were divided into high group(>420 μmol/L)and low group(<420 μmol/L) according to serum uric acid levels. Difference between the two groups has statistical significance on the thickness of the fibrous cap, lipid arc, invasion degree of macrophages, plaque rupture, thrombosis(P<0.001,P=0.002,P=0.025,P=0.007, P=0.001, respectively). Conclusion:Serum uric acid was an independent influence factor for TCFA.The instability of coronary atherosclerotic plaque was associated with elevated serum uric acid levels.
Objective:The study was designed to determine the relationship between the level of serum uric acid and thin-cap fibroatheroma(TCFA) detected by optical coherence tomography(OCT).Method:A total of 129 patients were recruited from the First Affiliated Hospital of Xinjiang Medical University from January 2015 to February 2018. CHD patient was diagnosed by coronary angiography. The parameters of coronary atherosclerotic plaque were determined based on OCT.The relationship between serum uric acid level and TCFA was analyzed by multiple logistic regression analysis.Result: A total of 129 patients were divided into non-TCFA group(96 cases) and TCFA group(33 cases) based on OCT.①Univariate analyses indicated that patients with TCFA had higher body mass index,smoking,low density lipoprotein,eGFR,uric acid and diabetes compared to those with non-TCFA.In addition, after adjusting for significant confounding factors including smoking,diabetes mellitus,low density lipoprotein, serum uric acid by multivariate regression analysis, multiple logistic regression analysis showed that smoking,diabetes mellitus,low density lipoprotein, and serum uric acid were affect factors of TCFA(P=0.016,P=0.007,P=0.005,P=0.025)and predictor of plaque instability.Serum uric acid was an independent risk factor for the TCFA(OR=1.007,95%CI:1.001-1.014,P=0.025).② Those patients were divided into high group(>420 μmol/L)and low group(<420 μmol/L) according to serum uric acid levels. Difference between the two groups has statistical significance on the thickness of the fibrous cap, lipid arc, invasion degree of macrophages, plaque rupture, thrombosis(P<0.001,P=0.002,P=0.025,P=0.007, P=0.001, respectively). Conclusion:Serum uric acid was an independent influence factor for TCFA.The instability of coronary atherosclerotic plaque was associated with elevated serum uric acid levels.
引文
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[20] Mishima M,Hamada T,Maharani N,et a1.Effects of uric acid on the NO production of HUVECs and its restoration by urate lowering agents[J].Drug Res(Stuttg),2016,66(5):270-274.
[21] Maxwel AJ,Bminsnm KA.Uric acid is closely Jinked to vascular nitric oxide activity.Evidence for mechanism of association with cardiovascular disease [J].J Am Coil Cardiol,2001,38(7):1850-1858.
[22] 贺磊,杨怡,田玥,等.高尿酸通过激活钙蛋白酶加重缺血/缺氧条件下小鼠心肌细胞凋亡[J].临床心血管病杂志,2017,33(10):1004-1008.
[23] Maruhashi T,Hisatome I,Kihara Y,et al.Hyperuricemia and endothelial function:From molecular background to clinical perspectives[J].Atherosclerosis,2018,278:226-231.
[24] Fruchart JC,Sacks F,Hermans MP,et al.The Residual Risk Reduction Initiative:a call to action to reduce residual vascular risk in patients with dyslipidemia[J].Am J Cardiol,2008,102(10 suppl):1k-34k.
[25] 王磊,马依彤,李晓梅,等.新疆维吾尔族人群血尿酸水平与冠心病的关联研究[J/CD].中华临床医师杂志,2011,5(2):382-386.
[2] 吴华芹,李莹,张并璇,等.胆红素对老年慢性心力衰竭全因死亡风险的预测价值及其影响因素[J].临床心血管病杂志,2018,34(1):52-57.
[3] Ranjith N,Myeni NN,Sartorius B,et al.Association Between Hyperuricemia and Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction[J].Metab Syndr Relat Disord,2017,15(1):18-25.
[4] 周京国.《中国高尿酸血症相关疾病诊疗多学科专家共识》解读[J].中华内科杂志,2017,56(13):22-22.
[5] Jia H,Abtahian F,Aguirre AD,et al.In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography[J].J Am Coll Cardiol,2013,62(19):1748-1758.
[6] Tian JW,Dauerman H,Toma C,et al.Prevalence and characteristics of TCFA and degree of coronary artery stenosis:an OCT,IVUS,and angiographic study[J].J Am Coll Cardiol,2014,64(7):672-680.
[7] Naghavi M,Libby P,Falk E,et al.From vulnerable plaque to vulnerable patient[J].Circulation,2003,108(14):1664-1672.
[8] Tian JW,Dauerman H,Toma C,et al.Prevalence and characteristics of TCFA and degree of coronary artery stenosis:an OCT,IVUS,and angiographic study[J].J Am Coll Cardiol,2014,64(7):672-680.
[9] 李全亮,张园,刘韵,等.血清尿酸与冠心病传统危险因素的相关性[J].实用医学杂志,2017,33(11):1786-1791.
[10] Luciano R,Shashaj B,Spreghini M,et al.Percentiles of serum uric acid and cardiometabolic abnormalities in obese Italian children and adolescents[J].Ital J Pediatr,2017,43(1):3-3.
[11] 芦永斌,程治远,赵亚学,等.血尿酸水平与冠心病发病关系的剂量-反应Meta分析[J].中国循环杂志,2016,31(7):640-643.
[12] 巩洁,任晖,高天林,等.冠心病患者血清尿酸与平均血小板体积的关系及二者对心血管事件的预测价值[J].中国动脉硬化杂志,2016,24(8):821-824.
[13] 彭丁,王韶屏,赵东晖,等.高尿酸血症与血运重建术后冠心病心力衰竭患者预后的关系[J].中华医学杂志,2018,98(17):1337-1341.
[14] Karabag Y,Rencuzogullari I,?agda? M,et al.Association of serum uric acid levels with SYNTAX score Ⅱ and long term mortality in the patients with stable angina pectoris who undergo percutaneous coronary interventions due to multivessel and/or unprotected left main disease[J].Int J Cardiovasc Imaging,2018.
[15] Kuwabara M,Niwa K,Hisatome I,et al.Asymptomatic Hyperuricemia Without Comorbidities Predicts Cardiometabolic Diseases:Five-Year Japanese Cohort Study[J].Hypertension,2017,69(6):1036-1044.
[16] Tian TT,Li H,Chen SJ,et al.Serum Uric Acid as an Independent Risk Factor for the Presence and Severity of Early-Onset Coronary Artery Disease:A Case-Control Study[J].Dis Markers,2018,2018:1236837.
[17] Richette P,Perez-Ruiz F,Doherty M,et a1.Improving cardiovascular and renal outcomes in gout:what should we Target?[J].Nat Rev Rheumatol,2014,10(11):654-661.
[18] 李红艳,芦良花,秦历杰,等.老年冠心病患者中血尿酸对血管内皮功能紊乱的影响[J].中国急救医学,2017,37(5):446-449.
[19] Kanellis J,Kang DH.Uric acid as a mediator of endothelial dysfunction,inflammation,and vascular disease[J].Semin Nephrol,2005,25(1):39-42.
[20] Mishima M,Hamada T,Maharani N,et a1.Effects of uric acid on the NO production of HUVECs and its restoration by urate lowering agents[J].Drug Res(Stuttg),2016,66(5):270-274.
[21] Maxwel AJ,Bminsnm KA.Uric acid is closely Jinked to vascular nitric oxide activity.Evidence for mechanism of association with cardiovascular disease [J].J Am Coil Cardiol,2001,38(7):1850-1858.
[22] 贺磊,杨怡,田玥,等.高尿酸通过激活钙蛋白酶加重缺血/缺氧条件下小鼠心肌细胞凋亡[J].临床心血管病杂志,2017,33(10):1004-1008.
[23] Maruhashi T,Hisatome I,Kihara Y,et al.Hyperuricemia and endothelial function:From molecular background to clinical perspectives[J].Atherosclerosis,2018,278:226-231.
[24] Fruchart JC,Sacks F,Hermans MP,et al.The Residual Risk Reduction Initiative:a call to action to reduce residual vascular risk in patients with dyslipidemia[J].Am J Cardiol,2008,102(10 suppl):1k-34k.
[25] 王磊,马依彤,李晓梅,等.新疆维吾尔族人群血尿酸水平与冠心病的关联研究[J/CD].中华临床医师杂志,2011,5(2):382-386.