摘要
目的旨在探讨青年痛风伴痛风石患者的临床特点及形成相关的危险因素,为青年痛风石的个体化诊疗提供临床依据。方法收集2016年9月至2020年6月期间来青岛大学附属医院痛风专病门诊就诊的原发性痛风患者,记录其相关临床资料,抽取空腹静脉血检测血尿酸、血糖血脂、肝功能、肾功能等,留取空腹晨尿检测尿pH值、尿尿酸、尿肌酐,根据年龄将患者分为青年痛风石组和青年无痛风石组。正态分布计量资料以±s表示,比较采用独立样本t检验和单因素方差分析;计数资料比较采用χ^(2)检验;危险因素分析采用Logistic回归分析。结果共收集原发性痛风患者4798例,其中合并皮下痛风石患者915例,青年痛风患者2308例,青年痛风石患者252例。青年痛风石组患者的平均BMI、腰围、臀围、TG水平、血尿酸水平、肾小球滤过率、ALT、AST明显高于中老年痛风石组患者(F=46.074,2.551,9.203,10.370,15.118,68.741,35.023,5.175,P均<0.05);青年痛风石组患者的平均起病年龄、收缩压、空腹血糖、尿FEUA、尿尿酸/尿肌酐、尿素氮水平明显低于中老年痛风石组患者,差异有统计学意义(F=474.876,7.629,6.441,34.877,3.633,50.867,P均<0.05)。青年痛风石患者年龄[(35±7)岁和(33±7)岁]、病程[(7±4)年和(4±3)年]、血压[(139±17)mmHg和(135±16)mmHg,(90±13)mmHg和(86±12)mmHg)]、TG[(2.6±2.1)mmol/L和(2.4±2.0)mmol/L]、总胆固醇[(4.9±1.4)mmol/L和(4.6±1.4)mmol/L]、血尿酸[(547±171)μmol/L和(490±160)μmol/L]、尿素氮[(5.0±2.0)mmol/L和(4.4±1.7)mmol/L]、合并家族史(27.0%和19.6%)及吸烟比率(56.0%和48.9%)明显高于青年无痛风石患者(t=4.717,P<0.05;t=12.838,P<0.05;t=3.414,P<0.05;t=4.676,P<0.05;t=2.085,P<0.05;t=2.451,P<0.05;t=5.308,P<0.05;t=4.090,P<0.05;χ^(2)=7.423,P<0.05;χ^(2)=4.235,P<0.05);而起病年龄[(28±6)岁和(29±7)岁)、肾小球滤过率[(96±21)ml·min^(-1)·1.73 m^(-2)和(103±21)ml·min^(-1)·1.73 m^(-2)]明显低于无痛风石患者,差异有统计学意义(t=-2.711,P<0.01;t=-4.907,P<0.01)。Logistics回归分析显示年龄、病程、血压、血脂、血尿酸、痛风家族史、吸烟是青年痛风石形成的危险因素,进一步校正年龄、病程、痛风家族史后,发现血尿酸、收缩压、舒张压、尿素氮仍然是青年痛风石的危险因素,肾小球滤过率仍然是保护因素。结论青年痛风石患者多合并肥胖、脂代谢紊乱;血尿酸水平、血压水平高及肾功能下降的青年痛风患者易出现皮下痛风石,临床中应注意关注,综合诊疗,预防或延缓痛风石的形成。
Objective To analyze the clinical characteristics and risk factors associated with the formation of subcutaneous tophi among young gout patients.Methods Gout patients treated at the Affiliated Hospital of Qingdao University from September 2016 to June 2020 were included.The clinical information was collected and relevant biochemical indices were detected.Fasting urine was collected to test urine pH value,urine uric acid and urine creatinine.Patients were divided into young tophi group and non-tophi group according to age.The measurement data of normal distribution was expressed as Mean±Standard deviation,and independent sample t test and one-way analysis of variance were used.The counting data was tested by Chi-square test.The risk factors were analyzed by logistic regression.Results A total of 4798 primary gout patients were collected.There were 915 patients with subcutaneous tophi,2308 young gout patients,252 young gouty tophi patients among them.The average BMI,waist circumference,hip circumference,triglyceride level,serum uric acid level,glomerular filtration rate,alanineamino-transferase(ALT)and aspartate amino-transferase(AST)in the young tophi group were significantly higher than those in the middle-age tophi group(F=46.074,2.551,9.203,10.370,15.118,68.741,35.023,5.175,all P<0.05).Average age of disease onset,systolic blood pressure,fasting blood glucose,urine FEUA,Uua/Ucr and urea nitrogen level in young tophi group were significantly lower than those in middle-age tophi group(F=474.876,7.629,6.441,34.877,3.633,50.867,all P<0.05].The age[(35±7)years old vs(33±7)years old],disease course[(7±4)years vs(4±3)years],blood pressure[(139±17)mmHg vs(135±16)mmHg],[(90±13)mmHg vs(86±12)mmHg],serum triglyceride[(2.6±2.1)mmol/L vs(2.4±2.0)mmol/L],total cholesterol[(4.9±1.4)mmol/L vs(4.6±1.4)mmol/L],serum uric acid[(547±171)μmol/L vs(490±160)μmol/L],urea nitrogen[(5.0±2.0)mmol/L vs(4.4±1.7)mmol/L],family history(27.0%vs 19.6%)and smoking rate(56.0%vs 48.9%)of tophi patients were significantly higher than those of non-tophi patients in young patients(t=4.717,P<0.05;t=12.838,P<0.05;t=3.414,P<0.05;t=4.676,P<0.05;t=2.085,P<0.05;t=2.451,P<0.05;t=5.308,P<0.05;t=4.090,P<0.05;χ^(2)=7.423,P<0.05;χ^(2)=4.235,P<0.05).The age of disease onset[(28±6)years vs(29±7)years]and glomerular filtration rate[(96±21)ml·min^(-1)·1.73 m^(-2)vs(103±21)ml·min^(-1)·1.73 m^(-2)]were statistically significantly lower than those of non-tophi patients(t=-2.711,P<0.01;t=-4.907,P<0.01).Logistics regression analysis showed that age,course of disease,blood pressure,blood lipids level,serum uric acid level,family history of gout and smoking were risk factors for the formation of tophi in young people.After further adjusted for age,course of disease and family history of gout,it was found that serum uric acid,systolic blood pressure,diastolic blood pressure and urea nitrogen remined risk factors for tophi,while glomerular filtration rate remained a protective factor in young patients.Conclusion Young tophi patients are always obese and have lipid metabolism disorder.Young patients with high level of serum uric acid and blood pressure,decreased renal function are prone to complicate with subcutaneous tophi.More attention should be paid in clinical practice to prevent or delay the formation of tophi.
作者
马利丹
刘甜
陈颖
程晓宇
孙瑞霞
辛颖
李长贵
贾兆通
Ma Lidan;Liu Tian;Chen Ying;Cheng Xiaoyu;Sun Ruixia;Xin Ying;Li Changgui;Jia Zhaotong(Department of Endocrinology and Metabolism,the Affiliated Hospital of Qingdao University,Shandong 266003,China)
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2021年第9期590-596,共7页
Chinese Journal of Rheumatology
基金
国家自然科学基金(81801434)。
