痛风亚临床冠脉钙化风险评估及早期CT检查的意义
投稿时间:2015-12-22  修订日期:2016-01-04  点此下载全文
引用本文:夏晓茹,周珍妮,陈阿丽,钱洋楠,邹东南,孙莉.痛风亚临床冠脉钙化风险评估及早期CT检查的意义[J].医学研究杂志,2016,45(6):142-146
DOI: 10.11969/j.issn.1673-548X.2016.06.036
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作者单位E-mail
夏晓茹 325035 温州医科大学附属第一医院风湿免疫科  
周珍妮 温州医科大学附属乐清医院内科  
陈阿丽 温州医科大学附属第一医院  
钱洋楠 温州医科大学  
邹东南 温州医科大学  
孙莉 325035 温州医科大学附属第一医院风湿免疫科 grassandsun@126.com 
中文摘要:目的 探讨原发性痛风患者亚临床冠状动脉钙化(CAC)的临床意义及相关风险因素评估,同时评价早期心脏多层计算机断层扫描(CT)的检查价值。方法 对温州医科大学附属第一医院确诊的325例高尿酸血症(HUA)患者进行常规心脏CT扫描,收集患者的临床资料和相关实验室检查,并根据症状将其分为伴发痛风的高尿酸血症组(GHU)及无症状高尿酸血症组(AHU),同期性别、年龄匹配的健康体检人群99例为对照组。分析冠脉钙化的发生情况差异,以及冠脉钙化发生的风险因素。结果 ①心脏CT平扫检查发现高尿酸血症患者冠脉钙化的发生率为36.9%,较对照组(10.1%)明显升高(P<0.01);GHU组发生冠脉钙化的发生率(48.9%)明显高于AHU组(10.8%,P<0.01);②存在冠脉钙化的人群血尿酸水平高于无冠脉钙化组(P=0.019);Pearson相关分析结果显示高尿酸血症与冠脉钙化呈正相关(r=0.099,P<0.05);③冠脉钙化与患者的年龄(r=0.500,P<0.01)、高血压(r=0.232,P<0.01)、TC(r=0.096,P<0.05)、LDL-C(r=0. 097,P<0.05)、HDL-C(r=-0.276,P<0.01)及伴发痛风(r=0.416,P<0.01)相关;④Logistic回归分析显示痛风、年龄、为冠脉钙化存在的独立危险因素,HDL-脂蛋白为冠脉钙化的保护因素。结论 CT检查发现无心脑血管疾病病史的高尿酸血症患者仍有较高的冠脉钙化发生率,尤其是有痛风病史的患者冠脉钙化发生率较高,需引起临床重视。高尿酸血症、年龄、高血压、高脂血症及伴发痛风与患者冠脉钙化发生密切相关,HDL-脂蛋白水平成为主要保护因素。
中文关键词:痛风  高尿酸血症  冠状动脉钙化  多层计算机断层扫描
 
Assessment of Risk in Gout with Subclinical Coronary Calcification and the Significance of Early CT Screening
Abstract:Objective To evaluate the incidence of subclinical coronary artery calcification(CAC) in primary gout and the associated factors, and estimate the significance of early detection with cardiac multidetector computed tomography (CT). Methods Totally 325 cases of hyperuricemia were admitted. Results of coronary artery calcification in cardiac CT scan, clinical data and blood tests were collected. All the patients were divided into 2 groups [hyperuricemia accompanying by gout (GHU) and asymptomatic hyperuricemia (AHU)]. Ninety-nine age-sex matched healthy donors were in control group. Incidence of CAC and risk factors in all cases were evaluated. Results ①It was revealed in cardiac CT scan examination that the incidence of hyperuricemia patients with CAC was 36.9%, which was significantly higher than in the control group (10.1%,P<0.01). The incidence of CAC in GHU group(48.9%) comparing with in AHU group(10.8%) was significantly(P<0.01). ②Serum uric acid levels in CAC group were much higher than in those without CAC (P=0.019). Pearson's correlation analysis indicated that hyperuricemia was related to CAC (r=0.099, P<0.05); ③CAC was associated with age (r=0.500, P<0.01), hypertension (r=0.232, P<0.01), total cholesterol (r=0.096,P<0.05),LDL-cholesterol (r=0. 097,P<0.05),HDL cholesterol levels (r=-0.276, P<0.01) and gout (r=0.416, P<0.01); ④Logistic regression analysis suggested that gout and age are true independent risk for CAC, while HDL cholesterol is a protective factor. Conclusion CT examination revealed hyperuricemia in patients without history of cerebrovascular disease still had high incidence of coronary artery calcification, especially those with gout. High attention need be paid to hyperuricemia, age, hypertension, HDL cholesterol and gout are closely related with CAC.
keywords:Gout  Hyperuricemia  Coronary artery calcification  Multidetector computed tomography
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