高尿酸血症和未治疗的痛风是近期急性心梗的不良预后因素

【摘要】 背景：有心肌梗死病史的患者通常发生再梗和死亡等并发症的风险增加。应用预后因素可能有助于预防这些不良后果的发生。高尿酸血症与冠心病和或死亡率的风险增加相关，然而，目前仍不清楚血清尿酸（sUA）水平能否预测心梗患者的预后。本研究的目的是评估高尿酸血症作为评估心梗后患者预后的生物标记物的作用。

方法：对来自阿司匹林心肌梗死研究（该研究为1：1随机对照双盲临床研究，从1975－1979年）的数据进行回顾性分析，分析了心梗患者每日服用阿司匹林3年后的死亡率。主要的终点事件设为全因死亡，CHD死亡，冠脉事件及中风，根据sUA水平进行四分位分析。对所有终点事件就是否存在痛风性关节炎问题进行了亚组分析。

结果：该研究纳入了4524名研究对象，对其中的4352组数据进行了分析。这些患者中，sUA数值位于第四分位水平组，其所有终点事件的发生率最高。在多元回归模型中，在最高四分位数的患者其危险比（HR）分别为：全因死亡率1.88(95%可信区间[CI],1.45-2.46),冠心病死亡率1.99(95% CI, 1.49-2.66)，冠脉事件1.36(95% CI, 1.08-1.70)。未经治疗的痛风患者其以上终点事件调整后的危险比为1.5-2.0(均P<0 .01)。接受治疗的痛风患者则不存在这些额外的风险。

结论：sUA和未经治疗的痛风可能是近期心肌梗死患者出现不良全因死亡及冠心病死亡率的独立预测因素。

附原文 Abstract Introduction: Patients with a history of myocardial infarction (MI) are often at risk for complications, including subsequent MI and death. Use of prognostic markers may aid in preventing these poor outcomes. Hyperuricemia is associated with increased risk for coronary heart disease (CHD) and/or mortality; however, it is unknown if serum urate (sUA) levels predict outcomes in patients with previous MI. The purpose of this study was to assess hyperuricemia as a biomarker of CHD outcomes in such patients. Methods: These were post hoc analyses of datasets from the Aspirin Myocardial Infarction Study, a 1:1 randomized, double-blind clinical trial, conducted from 1975 to 1979, that examined mortality rates following daily aspirin administration over 3 years in individuals with documented MI. The primary outcome measures were all-cause death, CHD mortality, coronary incidence, and stroke by quartile of baseline sUA. A sub-analysis of all outcome measures in the presence or absence of gouty arthritis was also performed. Results: Of 4,524 enrolled participants, data on 4,352 were analyzed here. All outcomes were greatest for patients in the fourth sUA quartile. In multivariate regression models, the hazard ratios (HR) for patients in the highest quartile were 1.88 for all-cause mortality (95% confidence interval [CI], 1.45-2.46), 1.99 for CHD mortality (95% CI, 1.49-2.66), and 1.36 for coronary incidence (95% CI, 1.08-1.70). Participants with untreated gout had an adjusted hazard ratios ranging from 1.5 to 2.0 (all P<0 .01) for these outcomes. participants with gout who were receiving treatment did not exhibit this additional risk. conclusions: sua and untreated gout may be independent prognostic markers for poor all-cause and chd mortality in patients with recent acute myocardial infarction.

引自：Hyperuricemia and untreated gout are poor prognostic markers among those with a recent acute myocardial infarction. Arthritis Research & Therapy 2012, 14:R10 doi:10.1186/ar3684