摘要目的 探讨不同血尿酸水平对急性ST段抬高心肌梗死患者的临床意义.方法 回顾性分析2005年1月至2010年12月北京中日友好医院收治的502例急性ST段抬高心肌梗死患者的临床资料,根据血尿酸水平分为高尿酸血症组(119例)和正常血尿酸组(383例),比较两组患者的血脂水平,超声心动图检查结果和住院期间的主要心血管不良事件.同时根据冠状动脉造影结果分析血尿酸水平与冠状动脉病变程度的关系.应用SPSS 17.0统计软件,数据分析采用t检验、x2检验和Pearson相关性检验.结果 血尿酸水平与甘油三酯水平呈正相关(r=0.11,P=0.018),在急性ST段抬高心肌梗死患者,高尿酸血症组高脂血症多见(43.7％ vs.33.7％,P=0.047),甘油三酯水平显著高于正常血尿酸组[(2.11±1.24)mmol/L vs.(1.78±1.38)mmol/L,P=0.014].血尿酸水平在不同冠状动脉病变支数组之间差异无统计学意义(P≥0.05).超声心动图检查发现高尿酸血症组左室舒张末径显著大于正常血尿酸组[(53.52 ±6.19)mmvs.(52.18±4.89)mm,P=0.041],左室收缩功能、舒张功能减低的发生率显著增加(36.4％ vs.15.1％,P＜0.01; 68.2％ vs.55.8％,P=0.023).搞尿酸血症组住院期间主要心血管不良事件的发生率显著高于正常血尿酸组(P＜0.05).结论 血尿酸水平与甘油三酯水平密切正相关,与冠状动脉病变严重程度无明显相关.在急性ST段抬高心肌梗死患者,高尿酸血症组左室收缩、舒张功能减低的发生率增加,主要心血管不良事件的发生率增加.

abstractsObjective To assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).Methods A total of 502 consecutive patients with STEMI were enrolled from January 2005 to December 2010 for retrospective study.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE)in patients with hyperuricemia(n =119)were compared with those in patients without hyperuricemia(n =383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software to make t test and x2 test and Pearson correlation analysis.Results Serum uric acid level was positively correlated with serum triglyceride level.Compared with non-hyperuricemia patients,hyperlipidemia was more commonly found among hyperuricemia patients (43.7％ vs.33.7％,P =0.047),and serum triglyceride level was significantly higher in hyperuricemia patients[(2.11 ± 1.24)mmol/L vs.(1.78 ± 1.38)mmol/L,P =0.014].But a significant association between serum uric acid level and one or more diseased vessels was not observed(P ≥ 0.05).Leftventricular end-diastolic diameter(LVEDd)was found to be larger in hyperuricemia patients than non-hyperuricemia patients[(53.52 ±6.19)mm vs.(52.18 ±4.89)mm,P =0.041].Higher incidence in left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4％ vs.15.1％,P ＜0.01; 68.2％ vs.55.8％,P =0.023).Also,hyp-eruricemia patients had more in-hospital MACE(P ＜ 0.05).Conclusions Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients after STEMI tended to have higher incidence in left systolic dysfunction and diastolic dysfunction,and have more in-hospital MACE.