2023 年第 9 期 第 18 卷

青年冠心病患者高尿酸血症患病情况及1年随访控制状况分析

Analysis of hyperuricemia and 1-year follow-up control in young patients with coronary atherosclerotic heart disease

作者：许锋1杨红霞1南楠1左惠娟2宋现涛1

英文作者：Xu Feng1 Yang Hongxia1 Nan Nan1 Zuo Huijuan2 Song Xiantao1

单位：1首都医科大学附属北京安贞医院心内科，北京100029；2首都医科大学附属北京安贞医院北京市心肺血管疾病研究所人群防治研究室，北京100029

英文单位：1Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Community Health Research Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；经皮冠状动脉介入；高尿酸血症；青年

英文关键词：Coronaryatheroscleroticheartdisease;Percutaneouscoronaryintervention;Hyperuricemia;Youth

• 摘要：

• 目的  了解初次诊断为冠心病（冠状动脉粥样硬化性心脏病）且接受经皮冠状动脉介入（PCI）治疗的18～44岁患者高尿酸血症患病情况及出院1年时控制情况。方法 本研究为回顾性和前瞻性相结合的队列研究。2017年1月开始，在首都医科大学附属北京安贞医院心内科门诊回顾性收集2016年1—12月以及前瞻性收集2017年1月至2018年12月初次诊断为冠心病并接受PCI治疗的18～44岁青年患者的住院信息、PCI术后1年时血尿酸水平。2019年12月完成所有信息的收集。分析患者血尿酸水平变化及1年随访时尿酸控制情况。结果 共纳入研究对象676例，男性634例（93.8%），年龄（39±4）岁。基线血尿酸水平为（387±93）μmol/L，1年随访时为（381±88）μmol/L，与基线比较差异无统计学意义（t=1.827、P=0.068）。不同性别、是否患高血压病、是否吸烟、不同高密度脂蛋白胆固醇（HDL-C）、三酰甘油以及体重指数水平患者基线血尿酸水平差异均有统计学意义（均P＜0.05）。调整基线血尿酸水平后，不同性别、不同三酰甘油水平患者1年随访时血尿酸水平差异均有统计学意义（均P＜0.05）。相关性分析结果显示，基线血尿酸水平与三酰甘油水平呈正相关（r=0.199，P＜0.001），与HDL-C及糖化血红蛋白水平呈负相关（r=-0.105、P=0.006，r=-0.101、P=0.004），与LDL-C水平无相关性（r=0.025，P=0.520）。基线时214例（31.7%）符合高尿酸血症诊断标准，1年随访时206例（30.5%）符合高尿酸血症的诊断标准。基线高尿酸血症患者中117例（54.7%）1年随访时血尿酸水平仍＞420 μmol/L，仅30例（14.0%）控制达标。基线血尿酸水平≤420 μmol/L者中，1年随访时19.3%（89/462）可以新诊断为高尿酸血症。结论 青年冠心病患者高尿酸血症患病率较高；出院1年时尿酸控制达标率低，血尿酸水平以及高尿酸血症患病率和基线相比没有明显改善。

• Objective To understand the hyperuricemia of 18-44-year-old patients who were initially diagnosed as coronary atherosclerotic heart disease and received percutaneous coronary intervention (PCI), and the control of hyperuricemia at discharge for 1 year. Methods This study was a retrospective and prospective cohort study. Starting from January 2017, hospitalization information and serum uric acid levels at 1-year after PCI  of 18-44-year-old young patients who were initially diagnosed with coronary atherosclerotic heart disease and received PCI treatment were collected retrospectively from January to December 2016 and collected prospectively from January 2017 to December 2018 at the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University. The collection of all information was completed in December 2019. Changes in serum uric acid levels and uric acid control at 1-year follow-up were analyzed. Results A total of 676 subjects were included in the study, including 634 males (93.8%), aged (39±4) years. The baseline serum uric acid level was (387±93)μmol/L, and it was (381±88)μmol/L at 1-year follow-up; there was no statistically significant difference compared to baseline (t=1.827, P=0.068). There were significant differences in baseline serum uric acid levels among patients with different states of gender, hypertension, smoking, high-density lipoprotein cholesterol (HDL-C), triacylglycerol and body mass index (all P＜0.05). After adjusting for baseline serum uric acid levels, there were statistically significant differences in serum uric acid levels among patients of different genders and levels of triacylglycerol at 1-year follow-up (all P＜0.05). The correlation analysis results  showed that baseline serum uric acid levels were positively correlated with triacylglycerol levels (r=0.199, P＜0.001), negatively correlated with HDL-C and glycosylated hemoglobin (r=-0.105, P=0.006; r=-0.101, P=0.004), and not correlated with low-density lipoprotein cholesterol (r=0.025, P=0.520). At baseline, 214 cases (31.7%) met the diagnostic criteria of hyperuricemia, and 206 cases (30.5%) met at 1-year follow-up. There were 117 cases (54.7%) of baseline hyperuricemia patients with serum uric acid level ＞420 μmol/L at 1-year follow-up, and only 30 cases (14.0%) were controlled to meet the standard. Among patients with baseline serum uric acid level ≤420 μmol/L, 19.3% (89/462) of patients could be newly diagnosed as hyperuricemia at 1-year follow-up. Conclusions  sHyperuricemia shows a high detection rate in young patients with coronary atherosclerotic heart disease. The rate of reaching the standard of serum uric acid control is low at 1 year after discharge, and the level of serum uric acid and the prevalence of hyperuricemia are not significantly improved compared with the baseline.