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Prognostic impacts of serum uric acid levels in patients with chronic heart failure -Insights from the CHART-2 Study-

藤橋 敬英 東北大学

2021.03.25

概要

研究目的:心不全患者における血清尿酸値とその予後との関係を詳細に明らかにすることを目的とした。

方法:慢性心不全患者の多施設前向き疫学研究である第二次東北慢性心不全登録研究(Chronic Heart failure Analysis and Registry in the Tohokudistrict-2、CHART-2研究)(N=10, 219)に登録されたアメリカ心臓病学会/アメリカ心臓協会(American College of Cardiology Foundation/American Heart Association、ACCF/AHA)における4, 652人のステージC/D患者を抽出し、尿酸値によって以下の4つの群に分類した:1群(<3.8mg/dL、N=313)、2群(3.8-7.1mg/dL、N=3, 070)、3群(7.2-9.2mg/dL、N=1, 018)、4群(>9.2mg/dL、N=251)。4群間で尿酸値の予後に与える影響を比較した。

結果:平均年齢は、1群、2群、3群、4群でそれぞれ71±12歳、69±12歳、68±13歳、69±15歳であった(P<0.001)。追跡期間中央値6.3年の間に、1群、2群、3群、4群でそれぞれ111人(35%)、905人(29%)、370人(36%)、139人(55%)が死亡し、79人(25%)、729人(24%)、300人(29%)、115人(46%)が心不全で入院した(いずれもP<0.001)。1群は、2群、3群、4群と比較して女性の割合が有意に高いことが特徴であった(それぞれ59%、32%、24%、23%)。多変量Cox比例ハザードモデルでは、2群と比較して、1群、4群では全死亡(1群, HR1.34、95%CI1.08-1.67、P=0.009;4群, HR1.28、95%CI1.02-1.61、P=0.037)と心不全入院(1群, HR1.39、95%CI1.09-1.78、P=0.008;4群, HR1.35、95%CI1.06-1.71、P=0.014)が増加した。さらに、2群から尿酸値が増加(HR1.29、95%CI1.06-1.57、P=0.012)または減少(HR1.57、95%CI1.12-2.20、P=0.009)した集団は、死亡率が高かった。

結論:慢性心不全患者において、尿酸値と予後の関係はU字型であり、経時的に尿酸値が上昇・低下すると予後不良である。

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