作者：汤群英，于建刚，徐红

单位：

214500 江苏省靖江市人民医院神经内科；通信作者：汤群英，E-mail：tqy2018jj@163.com

关键词：

卒中；动脉粥样硬化；动脉狭窄；尿酸；危险因素；影响因素分析

Keywords：

Stroke；Atherosclerosis；Arterial stenosis；Uric acid；Risk factors；Root cause analysis

CLC：

R 743　R 543.5

DOI：

DOI：10.3969/j.issn.1008-5971.2020.04.008

Funds：

摘要：

背景　血清尿酸（UA）水平升高可导致内皮细胞功能及血小板功能下降等而引起血栓形成，颅内外动脉粥样硬化性狭窄是脑梗死的主要病理基础，但血清 UA 水平对颅内外动脉粥样硬化性狭窄的影响目前尚不清楚。目的　探讨血清 UA 水平与老年脑梗死患者颅内外动脉粥样硬化性狭窄的关系。方法　选取 2017 年 6 月—2019 年 4月靖江市人民医院收治的老年脑梗死患者 198 例，根据颅脑 CT 血管造影检查结果分为对照组（非脑动脉粥样硬化性狭窄，n=58）和研究组（颅内 / 颅外动脉粥样硬化性狭窄，n=140）；另根据动脉粥样硬化性狭窄程度将 140 例颅内外动脉粥样硬化性狭窄患者分为轻度 56 例、中度 65 例和重度 19 例。比较对照组和研究组患者性别、年龄、合并症、吸烟史及实验室检查指标；比较轻、中、重度颅内外动脉狭窄患者血清 UA 水平；老年脑梗死患者颅内外动脉粥样硬化性狭窄的影响因素分析采用多因素 Logistic 回归分析。结果　研究组患者年龄大于对照组，高血压发生率、糖尿病发生率及总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、UA 水平高于对照组（P<0.05）。多因素 Logistic 回归分析结果显示，高血压〔OR=4.536，95%CI（1.227，16.765）〕、糖尿病〔OR=7.243，95%CI（1.283，40.882）〕、LDL-C ≥ 4.00 mmol/L〔OR=3.511，95%CI（1.994，12.407）〕、血清 UA 水平≥ 400 μmol/L〔OR=3.762，95%CI（1.032，13.717）〕是老年脑梗死患者颅内外动脉粥样硬化性狭窄的独立危险因素（P<0.05）。中、重度颅内外动脉粥样硬化性狭窄患者血清 UA 水平高于轻度者，重度颅内外动脉粥样硬化性狭窄患者血清 UA 水平高于中度者（P<0.05）。结论　血清 UA 水平≥ 400 μmol/L 是老年脑梗死患者颅内外动脉粥样硬化性狭窄的独立危险因素，且血清 UA 水平随老年脑梗死患者颅内外动脉粥样硬化性狭窄程度加重而升高。

Abstract：

Background　Elevation of serum uric acid（UA）level may lead to thrombogenesis through decreasingendothelial cell function and platelet function，intracranial/extracranial atherosclerotic stenosis is the main pathological basisof cerebral infarction，however impact of serum UA level on intracranial/extracranial atherosclerotic stenosis is not very clear atpresent. Objective　To investigate the relationship between serum UA level and intracranial/extracranial atherosclerotic stenosisin elderly patients with cerebral infarction. Methods　A total of 198 elderly patients with cerebral infarction were selected in thePeople's Hospital of Jingjiang from June 2017 to April 2019，and they were divided into control group（without atheroscleroticstenosis of cerebral artery，n=58）and study group（with intracranial/external atherosclerotic stenosis，n=140）；patientsin study group were divided into mild stenosis（n=56），moderate stenosis（n=65）and severe stenosis（n=19）accordingto degree of atherosclerotic stenosis. Gender，age，merged diseases，smoking history and laboratory examination resultswere compared between control group and study group；serum UA level was compared in patient with different degree ofatherosclerotic stenosis；multivariate Logistic regression analysis was used to analyze the influencing factors of intracranial/extracranial atherosclerotic stenosis in elderly patients with cerebral infarction. Results　Age in study group was older thanthat in control group，incidence of hypertension and diabetes mellitus，as well as TC，LDL-C and UA in study group werestatistically significantly higher than those in control group（P<0.05）.Multivariate Logistic results showed that，hypertension〔OR=4.536，95%CI（1.227，16.765）〕，diabetes mellitus〔OR=7.243，95%CI（1.283，40.882）〕，LDL-C ≥ 4.00mmol/L〔OR=3.511，95%CI（1.994，12.407）〕and serum UA level ≥ 400 μmol/L〔OR=3.762，95%CI（1.032，13.717）〕 were risk factors of intracranial/extracranial atherosclerotic stenosis in elderly patients with cerebral infarction （P<0.05）.Serum UA level in patients with moderate and severe intracranial/extracranial atherosclerotic stenosis was statistically significantlyhigher than that in patients with mild intracranial/extracranial atherosclerotic stenosis，respectively，meanwhile serum UA levelof in patients with severe intracranial/extracranial atherosclerotic stenosis was statistically significantly higher than that in patientswith moderate intracranial/extracranial atherosclerotic stenosis（P<0.05）.Conclusion　Serum UA level ≥ 400 μmol/L is oneof independent risk factors of intracranial/extracranial atherosclerotic stenosis in elderly patients with cerebral infarction，and theserum UA level increases as intracranial/extracranial atherosclerotic stenosis degree exacerbates in elderly patients with cerebralinfarction.

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