高尿酸血症对痰瘀互结型急性冠脉综合征患者PCI预后的影响

Effect of hyperuricemia on the prognosis of acute coronary syndrome patients with intermingled phlegm and blood stasis syndrome after PCI

关键词:  急性冠脉综合征  经皮冠状动脉介入  无症状高尿酸血症  倾向性评分匹配  痰瘀互结证

Key words:  acute coronary syndrome  percutaneous coronary intervention  asymptomatic hyperuricemia  propensity score matching  intermingled phlegm and blood stasis syndrome

摘要:

[目的] 基于真实临床诊疗数据，通过倾向性评分匹配法（PSM）探讨无症状高尿酸血症（HUA）对痰瘀互结型急性冠脉综合征（ACS）患者经皮冠状动脉介入（PCI）预后的影响，以便准确评估HUA患者心血管风险，为进一步探索中西医结合治疗方案提供理论基础。[方法] 通过医院信息系统，获得2019年1月至2023年6月所有在天津中医药大学第二附属医院诊断为痰瘀互结型ACS并行PCI治疗的45岁及以上患者住院资料，随访至PCI后12月，主要终点为主要不良心脑血管事件（MACCE），次要终点为心源性死亡、非致死性心肌梗死、卒中、新发或加重心力衰竭（HF）。根据血清尿酸（SUA）浓度将患者分为HUA组和非HUA组，通过1∶2 PSM平衡协变量，采用多因素Cox回归分析HUA对终点事件的影响。[结果] 共纳入484例患者，平均年龄（63.72±10.18）岁，74.59%为男性，25.41%为女性，与非HUA组相比，HUA组男性患者比例更高，诊断为ST 段抬高型心肌梗死患者更多。PSM后HUA组68例（33.66%），非HUA组134例（66.34%），两组间各协变量分布均衡。PSM后多因素Cox回归表明，与非HUA组相比，HUA组PCI后12月内MACCE发生风险增加139%[HR=2.39，95%CI（1.13，5.07），P＜0.05]、新发或加重HF发生风险增加272%[HR=3.72，95%CI（1.11，12.48），P＜0.05]，并且SUA浓度每升高1 μmol/L，MACCE发生风险增加0.6%[HR=1.006，95%CI（1.002，1.010），P＜0.05]，新发或加重HF发生风险增加0.6%[HR=1.006，95%CI（1.000，1.012），P＜0.05]，但两组心源性死亡、非致死性心肌梗死、卒中的发生风险差异无统计学意义（P＞0.05）。亚组分析进一步表明仅在年龄≥65岁、高血压、糖尿病、非ST段抬高型ACS、多支病变患者中，两组新发或加HF发生风险差异有统计学意义。[结论] 入院时合并无症状HUA与45岁及以上的痰瘀互结型ACS患者PCI预后不良相关，对新发或加重HF具有潜在预测价值。

Abstract:

[Objective] Based on real clinical data，this study employs propensity score matching （PSM） to explore the impact of concurrent asymptomatic hyperuricemia （HUA） on the prognosis of intermingled phlegm and blood stasis acute coronary syndrome （ACS） patients undergoing percutaneous coronary intervention（PCI）. This aims to accurately evaluate cardiovascular risks in HUA patients and provides a theoretical foundation for developing integrated treatment strategies that combine traditional Chinese and Western medical practices. [Methods] Data from inpatients aged 45 years or older diagnosed with intermingled phlegm and blood stasis syndrome ACS and undergoing PCI treatment were gathered via the hospital information system from January 2019 to June 2023 in Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine. Follow-ups continued up to 12 months post-PCI. The primary endpoint was major adverse cardiovascular and cerebrovascular events（MACCE），and the secondary endpoint included cardiac death，nonfatal myocardial infarction，stroke and new-onset or aggravated heart failure（HF）. Patients were categorized into HUA and non-HUA groups based on their serum uric acid concentration. Covariates were balanced by 1∶2 PSM，and the effects of HUA on endpoint events were analyzed by multivariate Cox regression. [Results] The study included 484 patients，with an average age of 63.72±10.18. The 74.59% were male and 25.41% were female. The proportion of males was higher in the HUA group compared to the non-HUA group，with a greater prevalence of ST-segment elevation myocardial infarction diagnoses. After PSM，there were 68 （33.66%） patients in the HUA group and 134 （66.34%） in the non-HUA group，with an equitable distribution of covariates. Post-PSM multivariate Cox regression revealed that compared with the non-HUA group，HUA group was associated with a 139% increase in the risk of MACCE[HR=2.39，95%CI（1.13， 5.07），P<0.05] and 272% increase in the risk of new-onset or aggravated HF [HR=3.72，95%CI（1.11，12.48），P<0.05] in 12 months post-PCI. Each 1 μmol/L increase in serum uric acid concentration was associated with a 0.6% increase in both the risk of MACCE [HR=1.006，95%CI（1.002，1.010），P<0.05] and new-onset or aggravated HF [HR=1.006，95%CI（1.000，1.012），P<0.05]. No difference was statistically in the risk of cardiac death，nonfatal myocardial infarction or stroke between two groups（P>0.05）. Subgroup analysis further showed that it was statistically different in the risk of new-onset or aggravated HF between 2 groups in those aged over 65 year，diagnosed with hypertension，diabetes，non-ST-segment elevation acute coronary syndrome and multiple-vessel lesion. [Conclusion] Concurrent asymptomatic HUA at admission is associated with the unfavorable prognosis of PCI in patients aged 45 years or older with intermingled phlegm and blood stasis syndrome ACS，and has potential predictive value for new-onset or aggravated HF.