合并高尿酸血症对老年缺血性脑卒中患者溶栓预后的影响

doi:10.3969/j.issn.1671-7171.2024.10.018

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摘要【目的】探讨合并高尿酸血症对老年缺血性脑卒中(CIS)患者溶栓预后的影响。【方法】回顾性分析100例老年CIS患者的临床资料,入院及溶栓治疗7 d时采用美国国立卫生研究院卒中量表(NIHSS)评分进行分组,≥5分为重度脑梗死(重度组),＜5分为轻度脑梗死(轻度组)。入院时重度组52例,轻度组48例,溶栓治疗7 d时重度组31例,轻度组69例;采用改良Rankin量表(mRS)评估患者溶栓治疗90 d的预后,根据预后分为mRS评分≤2分组(n=63)和mRS评分＞2分组(n=37)。分析老年CIS患者病情变化及溶栓预后的影响因素。【结果】入院时两组患者一般资料及合并高尿酸血症、高总胆固醇、高甘油三酯占比比较,差异均无统计学意义(P>0.05);溶栓治疗7 d, 重度组患者无高尿酸血症、高总胆固醇占比高于轻度组(P<0.05);多因素Logistic回归分析显示,高总胆固醇是影响溶栓治疗后病情严重程度的危险因素,高尿酸血症是保护因子(P<0.05);mRS评分＞2分组患者吸烟史、高尿酸血症、入院NIHSS评分≥5分、溶栓7 d NIHSS评分≥5分占比均高于mRS评分≤2分组(P<0.05);经多因素Logistic回归分析证实,合并高尿酸血症、吸烟史、入院NIHSS评分≥5分、溶栓7 d NIHSS评分≥5分是老年CIS患者90 d预后不良的危险因素(P<0.05)。【结论】尿酸在老年CIS患者溶栓早期能起到保护作用的因子,但仍会对患者溶栓治疗90 d预后产生不利影响,因此在老年CIS患者不同治疗阶段,合理控制尿酸水平,能有效改善病情严重程度及预后。

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	张玲
	王佳

关键词 ：卒中, 脑缺血, 高尿酸血症, 老年人, 预后

Abstract：【Objective】This study aims to investigate the impact of concomitant hyperuricemia on the thrombolytic prognosis in elderly patients with Cerebral Ischemic Stroke (CIS). 【Methods】 A retrospective analysis of the clinical data of 100 elderly CIS patients was conducted. Upon admission and after 7 days of thrombolytic treatment, patients were grouped based on the National Institutes of Health Stroke Scale (NIHSS): with scores ≥5 indicating severe cerebral infarction and scores <5 indicating mild cerebral infarction. Initially, 52 patients were classified as the severe group and 48 as the mild group. After 7 days of thrombolytic treatment, there were 31 cases in the severe group and 69 cases in the mild group. The modified Rankin Scale (mRS) was used to evaluate patient outcomes 90 days post-thrombolysis, with outcomes categorized as mRS scores≤2 (n=63) and mRS scores>2 (n=37). Factors influencing changes in patient conditions and thrombolytic prognosis were analyzed. 【Results】 At admission, there were no statistically significant differences between the two groups in terms of general data, presence of hyperuricemia, total cholesterol, and triglycerides (P>0.05). After 7 days of thrombolysis, the proportion of patients without hyperuricemia and with high total cholesterol in the severe group was greater than that in the mild group (P<0.05). Multivariate logistic regression analysis revealed that high total cholesterol was a risk factor for the severity of condition post-thrombolysis, while hyperuricemia acted as a protective factor (P<0.05). In the mRS scores>2 group, a higher proportion of patients had a history of smoking, hyperuricemia, NIHSS scores ≥5 at admission and NIHSS scores ≥5 at 7 days of thrombolysis than that in the mRS scores≤2 group (P<0.05). Multivariate logistic regression confirmed that concomitant hyperuricemia, smoking history, NIHSS scores ≥5 at admission, and NIHSS scores ≥5 at 7 days of thrombolysis were risk factors for poor 90 days outcomes in elderly CIS patients (P<0.05). 【Conclusion】 Uric acid can act as a protective factor in the early stage of thrombolysis in elderly CIS patients, but it may adversely affect the 90-day prognosis post-thrombolysis. Therefore, managing uric acid levels appropriately at different stages of treatment can effectively improve the treatment and prognosis of elderly CIS.

Key words： Stroke Brain Ischemia Hyperuricacidemia Aged Prognosis

收稿日期: 2023-08-10

中图分类号:

R743.33

通讯作者: *E-mail:122594479@qq.com

引用本文:

张玲, 王佳. 合并高尿酸血症对老年缺血性脑卒中患者溶栓预后的影响[J]. 医学临床研究, 2024, 41(10): 1519-1522.
ZHANG Ling, WANG Jia. Impact of Concomitant Hyperuricemia on Thrombolytic Prognosis in Elderly Patients with Cerebral Ischemic Stroke. JOURNAL OF CLINICAL RESEARCH, 2024, 41(10): 1519-1522.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2024.10.018 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2024/V41/I10/1519

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