【作者】 黎敏；

【导师】 唐震宇；

【作者基本信息】 南昌大学 ， 神经病学（专业学位）， 2015， 硕士

【摘要】 目的:研究显示高尿酸血症可能增加脑卒中事件风险,但是迄今为止,这两者的关系仍存在争议。因此,我们认为有必要运用meta分析的方法以系统地评价高尿酸血症与脑卒中发病/死亡是否存在关联。材料与方法:通过检索多个电子数据库并参考以前的meta分析文献,对2015年3月之前发表的有关高尿酸血症与脑卒中关系的文献进行筛选;此外,手工检索所得文献的参考文献作为补充。本研究全部纳入的文献为评价高尿酸血症与脑卒中发病/死亡关系的前瞻性队列研究。通过使用随机效应模型汇总各个报道了多因素调整后相应相对危险度(Relative Risk,RR)及其95%可信区间(Confidence Interval,CI)的研究。为了进一步深化结果和检验结果稳定性,本研究还进行了亚组分析、剂量反应关系分析、以及敏感性分析。发表偏倚检验通过检查漏斗图对称性和Begg’s秩检验实现。结果:总共15篇文献符合纳入标准,其中1篇文献纳入2个不同队列研究,因此,共16个前瞻性队列研究纳入meta分析,最终确定包括1048058参与者及23001例脑卒中的16项前瞻性研究结果用于评价高尿酸血症是否是脑卒中的危险因素。合并分析显示,高尿酸血症对脑卒中发病及死亡风险的RR值分别为1.21(1.08-1.35)、1.33(1.24-1.43)。异质性检验对应的P值分别为0.014(I2=51%)、0.128(I2=32.8%)。亚组分析结果显示,在男性人群中,高尿酸血症对脑卒中发病及死亡风险的RR值分别为1.15(0.92-1.44)、1.26(1.14-1.40);剂量反应关系分析结果显示,每升高1ml/dl的血清尿酸水平对应发生脑卒中死亡风险的RR值为1.30(1.02-1.67)。在女性人群中,高尿酸血症对脑卒中发病及死亡风险的RR值分别为1.19(1.04-1.36)、1.41(1.31-1.52);剂量反应关系分析结果显示,每升高1ml/dl的血清尿酸水平对应发生脑卒中死亡风险的RR值为1.35(1.08-1.70)。敏感性分析结果提示合并后的RR值较稳定。漏斗图及Begg’s检验结果均提示,脑卒中发病及死亡风险不存在发表偏倚,对应的P值分别为0.91、0.73。结论:当前的meta分析研究结果提示,高尿酸血症增加脑卒中发病及死亡风险;在男性及女性人群中,血清尿酸水平与脑卒中死亡风险呈现剂量反应关系。未来需要更多的证据证实高尿酸血症是否为影响脑卒中发病风险的可调整因素。更多还原

【Abstract】 Objective: Hyperuricemia may be associated with an increased risk of stroke, but to date results from prospective studies have been inconsistent. This study aimed to evaluate the association between hyperuricemia and risk of stroke incidence and mortality by performing a meta-analysis.Materials and Methods: Studies were identified by searching multiple electronic databases through March, 2015, and by reviewing reference lists of obtained articles. Prospective studies reported a multivariate-adjusted estimate, represented as relative risk(RR) with 95% confidence interval(CI) for the association between hyperuricemia and risk of stroke incidence and mortality were eligible. A random-effects model was used to compute the pooled risk estimate. Subgroup analyses, sensitivity analyses, and dose-response analyses were also performed. Funnel plots and Begg’s statistical analyses were used to examine potential publication bias.Results: A total of fifteen articles including results from 16 prospective studies with 23001 cases of stroke and 1048058 participants were included in the meta-analysis. Overall, presence of hyperuricemia was associated with a significantly greater risk of both stroke incidence(RR, 1.21; 95% CI, 1.08 to 1.35) and mortality(RR, 1.33; 95% CI, 1.24 to 1.43). In addition, the pooled estimate of multivariate RRs of stroke incidence and mortality were 1.15(95% CI: 0.92-1.44); 1.26(95% CI: 1.14-1.40) among men and 1.19(95% CI: 1.04-1.36); 1.41(95% CI: 1.31-1.52) among women respectively. In the dose-response analyses, the summary RRs of hyperuricemia were 1.30(95% CI: 1.02-1.67) for every 1mg/dl increase among men and 1.35(95% CI: 1.08-1.70) for every 1 mg/dl increase among women. In the sensitivity analyses, the results supported the robustness of the findings. There was no evidence of publication bias for stroke incidence and mortality. The P values of Begg’s were 0.91 and 0.73 respectively.Conclusions: Results from this meta-analysis indicate that hyperuricemia may modestly increase the risks of both stroke incidence and mortality. Among men and women, these results from stroke mortality were consistent with dose-response relationships. Future studies should explore whether hyperuricemia is a modifiable risk factor for stroke.更多还原