| Objective: Intracranial atherosclerotic stenosis(ICAS)is a major risk factor for ischemic stroke and/or transient ischemic attack(TIA).As is known to all,stroke has the clinical characteristics of high disability and high mortality rate.Hence,identifying the risk factors for ICAS,finding new treatment targets and improving prevention strategies are highly warranted.In recent years,the incidence of hyperuricemia(HUA)in China has shown a signicant increase.Serum uric acid is the product of purine metabolism.Previous studies have found that uric acid has an oxidative effect,giving rise to a vicious cycle of endothelial cell damage leading to the development of atherosclerosis.However,the relationship between uric acid and atherosclerosis still remains controversial.At present,most researches mainly focused on the relationship of HUA with cardiovascular disease,but a few studies have focused on the association between uric acid and ICAS.In this study,we aimed to investigate the relationship between serum uric acid and the risk of ICAS in non-acute stroke population.Methods: After strict quality control screening,a total of 1,522 non-stroke patients aged 40 to 90 admitted to Qingdao Municipal Hospital from January 2013 to June 2018 were included in the study.All enrolled patients have tested for serum uric acid level by circulating enzyme method,and underwent brain MRI and MRA examinations.ICAS was defined as the presence of ? 50% atherosclerotic stenosis or occlusion in one or more large intracranial arteries.All participants were divided into ICAS group(305 participants)and non-ICAS group(1217 participants)based on the results of the MRA examination.And according to the decile of uric acid level,the subjects were divided into ten groups: ? 3.8,3.9-4.4,4.5-4.8,4.9-5.1,5.2-5.5,5.6-5.9,6.0-6.3,6.4-6.9,7.0-7.7,and ? 7.8 mg/dL.We used t-test,?2-test and oneway ANOVA to examine subgroup differences in our analyses.Then we used linear regression,quadratic non-linear regression,multivariate logistic regression and quadratic multivariate logistic regression to further investigate the relationship between serum uric acid and the risk of ICAS.All of the above multivariate regression analyses were adjusted for age,gender,high-density lipoprotein(HDL),creatinine,hypertension,diabetes,coronary heart disease,smoking and drinking.A probability value of P ? 0.05 was considered statistically significant.All statistical tests were performed with the R software(version 3.4.2).Results: All subjects were categorized into ten groups according to the deciles of SUA level.Oneway ANOVA analysis showed that there was a significant difference in the incidence of ICAS among the decile subgroups(P = 0.018),and the incidence of ICAS was lowest in the seventh decile(6.0-6.3mg/dL).A U-shaped association between ICAS and the mean SUA level of each subgroup was identified using a quadratic non-linear model(P < 0.001).Multiple logistic regression analysis demonstrated that both the first decile group(? 3.8mg/dL,OR,2.37;95% CI,1.30-4.42;P = 0.006)and the tenth decile group(? 7.8mg/d L,OR,2.08;95% CI,1.14-3.88;P = 0.018)were associated with higher risks for ICAS,with the seventh decile as the reference group.The U-shaped relationship between SUA and the rate of ICAS was confirmed(? > 0;P < 0.001)by quadratic multivariable logistic analyses that used SUA as a continuous variable.Moreover,analyses indicated that the SUA level associated with the lowest rate of ICAS was 6.2 mg/d L.Conclusion: There was a U-shaped relationship between serum uric acid level and the incidence of ICAS.Both the low uric acid level and the high uric acid level conferred greater risk for ICAS.And the lowest rate of ICAS was observed when the SUA level was 6.2 mg/dL.The results of this study will facilitate further studies of mechanism of serum uric acid in intracranial atherosclerosis,and provide reliable guidance for controlling serum uric acid level to reduce the incidence of ICAS. |
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