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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2019, Vol. 05 ›› Issue (04) : 201 -205. doi: 10.3877/cma.j.issn.2095-9141.2019.04.003

所属专题： 文献；

临床研究

血清尿酸与动脉瘤性蛛网膜下腔出血患者Hunt-Hess分级及短期预后相关性研究
刘洋1, 刘秀2, 张玺3, 孙圣凯4, 王志宏5,†()   
  1. 1. 201100　上海市闵行区中心医院神经内科
    2. 300000，天津市西青医院老年医学科
    3. 200081　上海市第四人民医院神经内科
    4. 300162　天津，武警医学特色中心（原武警后勤学院附属医院）科研科
    5. 300150　天津，天津中医药大学第二附属医院老年医学科
  • 收稿日期:2019-04-04 出版日期:2019-08-15
  • 通信作者: 王志宏
  • 基金资助:
    上海市虹口区卫计委医学科研面上项目(虹卫1802-06); 同济大学"中央高校基本科研业务费专项资金"项目(22120180282)

Correlation of serum uric acid concentration with Hunt-Hess grade and short-term prognosis in patients with aneurysmal subarachnoid hemorrhage

Yang Liu1, Xiu Liu2, Xi Zhang3, Shengkai Sun4, Zhihong Wang5,†()   

  1. 1. Department of Neurology, Minhang District Central Hospital of Shanghai, Shanghai 201100, China
    2. Department of Geriatric Medicine, Tianjin Xiqing Hospital, Tianjin 300000, China
    3. Department of Neurology, Shanghai Fourth People’s Hospital, Shanghai 200081, China
    4. Department of Medicine and Scientific Research, Armed Police Medical Characteristic Center (Affiliated Hospital of Armed Police Logistics College), Tianjin 300162, China
    5. Department of Geriatric Medicine, Second Affiliated Hospital of Tianjin University of TCM, Tianjin 300150, China
  • Received:2019-04-04 Published:2019-08-15
  • Corresponding author: Zhihong Wang
  • About author:
    Corresponding author: Wang Zhihui, Email:
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刘洋, 刘秀, 张玺, 孙圣凯, 王志宏. 血清尿酸与动脉瘤性蛛网膜下腔出血患者Hunt-Hess分级及短期预后相关性研究[J]. 中华神经创伤外科电子杂志, 2019, 05(04): 201-205.

Yang Liu, Xiu Liu, Xi Zhang, Shengkai Sun, Zhihong Wang. Correlation of serum uric acid concentration with Hunt-Hess grade and short-term prognosis in patients with aneurysmal subarachnoid hemorrhage[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2019, 05(04): 201-205.

目的

探讨血清尿酸（SUA）与动脉瘤性蛛网膜下腔出血（aSAH）Hunt-Hess（H-H）分级及短期预后之间的相关性。

方法

回顾性分析武警医学特色中心脑科中心自2012年1月至2018年12月收治的293例aSAH患者的临床资料，搜集纳入患者的H-H分级、SUA水平、性别、年龄、高血压病史及出院时GOS评分等资料。根据入院时SUA水平、病情的轻重（H-H分级）、转归分别进行分组，分析SUA与aSAH患者H-H分级及短期预后之间的关系，以及影响aSAH患者入院H-H分级不同的因素。

结果

3组aSAH患者不同SUA水平的H-H分级比较，差异具有统计学意义（χ2=10.790，P=0.005）。Logistic回归分析显示，SUA的不同是造成H-H分级不同的独立危险因素（P<0.05）。不同SUA水平患者的预后良好率比较，差异均具有统计学意义（P<0.05）。入院H-H 4~5级与H-H 1~3级的预后良好率比较，差异具有统计学意义（P<0.05）。

结论

aSAH患者入院时SUA水平不同，其H-H分级也不同，SUA的不同是造成H-H分级不同的独立危险因素，SUA水平差异一定程度提示aSAH患者短期预后不同。

关键词: 动脉瘤性蛛网膜下腔出血, 血清尿酸, Hunt-Hess分级
Objective

To investigate the correlations between serum uric acid(SUA) concentration, Hunt-Hess (H-H) grade and short-term prognosis in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods

Two hundred and ninety-three patients with aSAH who had been admitted to the Brain Center, Armed Police Medical Characteristic Center from January 2012 to December 2018 were retrospectively analyzed. The patients were collected for H-H classification, SUA level, gender, age, history of hypertension, and GOS score at discharge. According to the SUA level at admission, the severity of the disease (H-H grade), and the outcome were grouped separately, the relationship between SUA and aSAH patients with Hunt-Hess grade and short-term prognosis was analyzed, and the factors influencing the H-H classification of patients with aSAH were analyzed.

Results

There were significant differences in H-H classification of different SUA levels among 3 groups of patients with aSAH (χ2=10.790, P=0.005). Logistic stepwise regression analysis showed that the difference in SUA was an independent risk factor for different HH grades (P<0.05). There were significant differences in the prognosis of patients with different SUA levels (P<0.05). The prognosis of patients with H-H 4-5 and H-H 1-3 was statistically significant (P<0.05).

Conclusion

The level of SUA was different in aSAH patients at admission, and the H-H grading was also different., the difference of SUA was an independent risk factor for different H-H grade, and the difference of SUA level suggested that the short-term prognosis of patients with aSAH was different to some extent.

Key words: Aneurysmal subarachnoid hemorrhage, Serum uric acid, Hunt-Hess grade
表1 3组临床基础资料比较
组别 例数 男/女 30~45岁/46~70岁 吸烟史 饮酒史 高血压病史
SUA升高组 29 16/13 17/12 16 15 17
SUA降低组 67 38/29 33/34 35 32 30
SUA正常组 197 128/69 101/96 118 79 94
χ2值 ? 2.108 0.728 1.285 2.195 1.594
P值 ? 0.348 0.695 0.526 0.334 0.451
表2 3组aSAH患者的H-H分级比较[例（%）]
组别 例数 H-H 1~3级 H-H 4~5级
SUA升高组 29 9（31.0） 20（69.0）
SUA降低组 67 57（85.1） 10（14.9）
SUA正常组 197 124（62.9） 73（37.1）
χ2值 ? 10.790
P值 ? 0.005
图1 血清尿酸与Hunt-Hess分级的关系
表3 造成aSAH患者入院H-H分级不同的单因素分析[例（%）]
因素 H-H 1~3级（n=190） H-H 4~5级（n=103） χ2值 P值
性别 ? ? 18.432 0.000
? 男 101（55.5） 81（44.5） ? ?
? 女 89（80.2） 22（19.8） ? ?
年龄（岁） ? ? 17.157 0.000
? 30~45 81（53.6） 70（46.4） ? ?
? 46~70 109（76.8） 33（23.2） ? ?
高血压病史 ? ? 32.932 0.000
? 有 68（48.2） 73（51.8） ? ?
? 无 122（80.3） 30（19.7） ? ?
SUA ? ? 26.883 0.000
? SUA升高组 9（31.0） 20（69.0） ? ?
? SUA降低组 57（85.1） 10（14.9） ? ?
? SUA正常组 124（62.9） 73（37.1） ? ?
表4 造成aSAH患者入院H-H分级不同的多因素分析
因素 偏回归系数 标准误 Wald值 P值 OR值 95%CI
性别 ? ? ? ? ? ?
? 男 ? ? ? ? 1（Ref） ?
? 女 -0.219 0.323 4.763 0.500 1.075 0.426~1.517
年龄（岁） ? ? ? ? ? ?
? 30~45 ? ? ? ? 1（Ref） ?
? 46~70 0.023 0.012 12.51 0.912 0.493 0.684~1.529
高血压病 ? ? ? ? ? ?
? 有 ? ? ? ? 1（Ref） ?
? 无 0.155 0.612 0.227 0.300 1.128 0.871~1.564
SUA ? ? ? ? ? ?
? SUA正常组 ? ? ? ? 1（Ref） ?
? SUA降低组 0.785 0.003 1.167 0.007 1.284 1.105~3.403
? SUA升高组 0.573 0.002 1.379 0.006 1.135 1.341~3.542
表5 aSAH患者不同SUA水平的预后比较[例（%）]
组别 例数 预后良好 预后不良
SUA升高组 29 13（44.8） 16（55.2）
SUA正常组 197 143（72.6） 54（27.4）
SUA降低组 67 46（68.6） 21（31.4）
χ2值 ? 9.102
P值 ? 0.011
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