脑血管病急性期血尿酸/血肌酐比值与脑血管事件复发及死亡的关系：一项前瞻性队列研究

BackgroundStroke is featured by high mortality and recurrent rate worldwide. Serum uric acidSUA is the product of purine metabolism that has been identified as a risk factor for cardiovascular disease. The serum uric acid/serum creatinine ratioSUA/Scris a renal function-normalized SUA. The role of SUA/Scr in acute cerebrovascular disease remains controversial. ObjectiveTo identify the correlation of SUA/Scr with the recurrence and mortality of cerebrovascular events in patients with acute cerebrovascular disease. MethodsThis was a prospective cohort study involving patients with the initial cerebrovascular event consecutively admitted in Tianjin Huanhu Hospital from September 2006 to September 2019. All patients were followed up in the outpatient clinic combined with telephone contact until September 2020. The primary outcome was all#2;cause mortality. The secondary outcomes were recurrent cerebrovascular eventsrecurrent cardiovascular events and other vascular eventse.g.arteriovenous thrombosis of lower extremities. Cox proportional hazard models were used to explore the correlation of SUA/Scr with the recurrence and mortality of cerebrovascular events in patients with acute cerebrovascular disease. ResultsAccording to the quartiles of SUA/Scr levelspatients with acute cerebrovascular disease were divided into Q1 group SUA/Scr 3.16n=3 520Q2 group3.164.92n=3 243. At the end of the follow-up7745.8%patients diedwhile 2 06415.5% reported recurrences of cerebrovascular events. In Q1-Q4 groupsthere were 302375408 and 337 male cases of recurrences of cerebrovascular eventsand 99125169 and 249 female cases of recurrences of cerebrovascular eventsrespectively. There were 261314345 and 283 male cases of recurrences of cerebral infarctionand 90101142 and 205 female cases of recurrences of cerebral infarction in Q1-Q4 groupsrespectively. There were 154191214 and 183 male cases of recurrences of large atherosclerotic cerebral infarctionand 585245 and 31 female cases of recurrences of large atherosclerotic cerebral infarction in Q1-Q4 groupsrespectively. All-cause mortality in men was 165128131 and 88 cases in Q1-Q4 groups respectivelyand 576362 and 80 cases in women. The mortality of men due to cerebral infarction was 937270and 46 cases in Q1-Q4 groupsrespectivelyand 313336and 44 cases in women. The mortality of men due to large artery atherosclerotic cerebral infarction was 585245and 31 cases in Q1-Q4 groupsrespectivelyand 293742 and 37 cases in women. After adjusting for multiple confounding factorsSUA/Scr in Q4 compared with Q1 was an influencing factor for the recurrence of acute cerebral infarction in men HR=0.69095%CI=0.500-0.953P=0.026. SUA/Scr in Q4 compared with Q1 was an influencing factor for the recurrence of large artery atherosclerotic cerebral infarction in the male cerebral infarction subgroup HR=0.74095%CI=0.578-0.947P=0.017. SUA/Scr in Q4 compared with Q1 was an influencing factor for all#2;cause mortality HR=0.57595%CI=0.368-0.901P=0.003 and death from cerebral infarction in men HR=0.610 95%CI=0.353-0.814P=0.011. SUA/Scr in Q3 HR=0.65695%CI=0.476-0.904P=0.010 and Q4 HR=0.582 95%CI=0.409-0.829P=0.001 compared with Q1 was an influencing factor for male death after discharge. SUA/Scr in Q4 compared with Q1 was an influencing factor for death due to large artery atherosclerotic cerebral infarction in the male cerebral infarction subgroup HR=0.58095%CI=0.386-0.873P=0.007. ConclusionWithin a certain rangethe increased SUA/ Scr ratio in the acute stage of cerebrovascular disease has a certain protective effect on the recurrence and death of cerebrovascular events in male patients. Low SUA/Scr ratio is associated with the increased risk of death and recurrence of male patients with large artery atherosclerotic cerebral infarctionbut not correlated with small artery occlusion cerebral infarction and cardiogenic stroke. SUA/Scr is not correlated with cerebrovascular event recurrence or death in female patients.