Tầm quan trọng của việc đưa axit uric vào định nghĩa hội chứng chuyển hóa khi đánh giá nguy cơ tử vong

Clinical Research in Cardiology - Tập 110 - Trang 1073-1082 - 2021
Nicola Riccardo Pugliese1, Alessandro Mengozzi, Agostino Virdis1, Edoardo Casiglia2, Valerie Tikhonoff3, Arrigo F. G. Cicero4, Andrea Ungar5, Giulia Rivasi5, Massimo Salvetti6, Carlo M. Barbagallo7, Michele Bombelli8, Raffaella Dell’Oro8, Berardino Bruno9, Luciano Lippa10, Lanfranco D’Elia11, Paolo Verdecchia12, Francesca Mallamaci13, Massimo Cirillo14, Marcello Rattazzi15, Pietro Cirillo16, Loreto Gesualdo16, Alberto Mazza17, Cristina Giannattasio18, Alessandro Maloberti18, Massimo Volpe19,20, Giuliano Tocci19,20, Georgios Georgiopoulos21, Guido Iaccarino22, Pietro Nazzaro23, Gianfranco Parati24,25, Paolo Palatini2, Ferruccio Galletti11, Claudio Ferri9, Giovambattista Desideri9, Francesca Viazzi26, Roberto Pontremoli26, Maria Lorenza Muiesan6, Guido Grassi8, Stefano Masi1, Claudio Borghi4
1Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
2Department of Medicine, University of Padua, Padua, Italy
3Department of Medicine and Studium Patavinum, University of Padua, Padua, Italy
4Department of Medical and Surgical Science, Hypertension and Cardiovascular Risk Factors Research Center, Alma Mater Studiorum University of Bologna, Bologna, Italy
5Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
6Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
7Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
8Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
9Department of Life, Health, and Environmental Sciences, University of l'Aquila, l'Aquila, Italy
10Italian Society of General Medicine, Avezzano, Italy
11Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
12Hospital S. Maria della Misericordia, Perugia, Italy
13Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, CNR-IFC, Reggio Calabria, Italy
14Department of Public Health, University of Naples Federico II, Naples, Italy
15Department of Medicine, Medicina Interna 1°, Ca’ Foncello University Hospital, University of Padova, Treviso, Italy
16Department of Emergency and Organ Transplantation–Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
17Department of Internal Medicine, Hypertension Unit, General Hospital, Rovigo, Italy
18Cardiology IV, A. De Gasperis Department, Health Science Department, Niguarda Ca’ Granda Hospital, Milano-Bicocca University, Milan, Italy
19Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, University of Rome Sapienza, Rome, Italy
20IRCCS Neuromed, Pozzilli, Italy
21First Department of Cardiology, Medical School, Hippokration Hospital, University of Athens, Athens, Greece
22Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
23Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
24Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS S. Luca Hospital, Lucca, Italy
25Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
26Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genoa, Italy

Tóm tắt

Axit uric huyết tương (SUA) đã được mô tả như là một yếu tố nguyên nhân góp phần vào hội chứng chuyển hóa (MS), điều này, đến lượt nó, dự báo tiên lượng không thuận lợi. Chúng tôi đã đánh giá vai trò tiên đoán của SUA ở những bệnh nhân có và không có MS. Chúng tôi đã sử dụng dữ liệu từ nghiên cứu đa trung tâm 'Axit Uric Đúng cho Sức Khỏe Tim Mạch' và xem xét tỷ lệ tử vong tim mạch (CVM) như là cái chết do nhồi máu cơ tim tử vong, đột quỵ, tử vong tim đột ngột hoặc suy tim. Tổng cộng 9.589 đối tượng (tuổi trung vị 58,5 năm, 45% nam giới) đã được đưa vào phân tích, và 5.100 (53%) bệnh nhân có chẩn đoán cuối cùng là MS. Sau thời gian theo dõi trung vị là 142 tháng, chúng tôi đã quan sát thấy 558 sự kiện. Sử dụng một ngưỡng SUA tim mạch đã được xác nhận trước đó để dự đoán CVM (> 5.1 mg/dL ở phụ nữ và 5.6 mg/dL ở nam giới), mức SUA cao hơn có liên quan đáng kể đến kết quả xấu hơn ở bệnh nhân có và không có MS (tất cả p < 0.0001) và cung cấp sự cải thiện phân loại rủi ro đáng kể là 7.1% so với chẩn đoán bệnh MS trong trường hợp CVM (p = 0.004). Phân tích hồi quy Cox đã xác định được một mối liên hệ độc lập giữa SUA và CVM (Tỉ lệ Nguy cơ: 1.79 [95% CI, 1.15–2.79]; p < 0.0001) sau khi điều chỉnh cho MS, các thành phần đơn lẻ của nó và chức năng thận. Ba sự kết hợp cụ thể của các thành phần MS có liên quan đến CVM cao hơn khi mức SUA gia tăng được ghi nhận, và tăng huyết áp hệ thống là thành phần cá nhân duy nhất luôn hiện diện (tất cả p < 0.0001). Mức SUA tăng cao hơn có liên quan đến nguy cơ CVM cao hơn bất kể sự hiện diện của MS: một ngưỡng SUA tim mạch có thể cải thiện phân loại rủi ro.

Từ khóa

#axit uric #hội chứng chuyển hóa #tỷ lệ tử vong tim mạch #nguy cơ #phân loại rủi ro

Tài liệu tham khảo

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Clinical Research in Cardiology

Tập 110

1073-1082

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