摘要
目的探讨老年起病痛风性关节炎的临床特点及易患痛风石的相关危险因素。方法回顾性选取2016年至2022年在青岛大学附属医院痛风临床医学中心门诊就诊的痛风患者1239例。按发病年龄分为两组,中青年组(<60岁)826例与老年组(≥60岁)413例。比较分析两组临床特征加老年人易发痛风石的危险因素。结果老年组收缩压、空腹血糖、肌酐、规律运动比例、合并症、痛风石发生率均高于中青年组;舒张压、三酰甘油、估算的肾小球滤过率(eGFR)、血尿酸、饮酒率、痛风家族史的比例等低于中青年组(P<0.05);老年起病组关节炎首发部位多见于第一跖趾关节,初次发作为上肢关节者人数多于中青年患者(P<0.05)。老年起病组尿酸排泄分型以肾脏排泄不良型多见,肾负荷过多型所占比例高于中青年组(P<0.05)。二元logistic回归分析显示年龄、尿素氮、痛风家族史、病程≥10年是老年患者发生痛风石的危险因素(P<0.05)。结论老年起病的痛风群体有其独特的临床特征,表现为痛风石多见、合并症比率高。关节炎首发部位多见于第一跖趾关节,尿酸排泄分型以肾脏排泄不良型为主。应早期诊疗、控制血尿酸水平、戒烟戒酒、规律运动,以预防或延缓痛风石的形成。
Objective To analyze the clinical characteristics of elderly-onset gouty arthritis and risk factors of tophi.Methods A total of 1239 gout patients were retrospective selected in the outpatient department of the Gout Clinical Medical Center of the Affiliated Hospital of Qingdao University from 2016 to 2022.According to age of onset,they were divided into the young and middle-aged group(aged<60)consisted of 826 cases,and the elderly group(aged≥60)consisted of 413 cases.Compare the clinical characteristics of elderly with Young and Middle-aged patients.Results The systolic blood pressure,fasting blood glucose,creatinine,regular exercise,comorbidities,and tophi in the elderly group was higher than that in the middle-aged and young group.The proportion of diastolic blood pressure,serum triglycerides,eGFR,serum uric acid,alcohol consumption rate,and family history of gout was lower than that of young and middle-aged group(P<0.05);In the elderly-onset group,the initial site of arthritis was commonly observed in the first metatarsophalangeal joint.The proportion of the first attack with the upper limb joint was higher in old age group than in young and middle age group(P<0.05).Renal underexcretion type was the main subtype in the elderly group,and the proportion of overproduction type was higher than that of the young and middle-aged group(P<0.05).The logistic regression analysis showed that age,urea nitrogen,disease duration≥10 years and family history of gout were risk factors for tophi in elderly patients(P<0.05).Conclusion The elderly-onset gout has unique clinical characteristics,characterized by a higher prevalence of tophi,a higher rate of complications.An initial site of arthritis commonly observed in the first metatarsophalangeal joint and the predominant type of uric acid excretion is renal excretion impairment.Early diagnosis and treatment,control of blood uric acid levels,smoking cessation and alcohol,regular exercise should be applied to prevent or delay the formation of tophi.
作者
狄舒婷
冶洪
周诗喆
马利丹
季爱昌
程晓宇
刘甜
杨敏
尉雅洁
陈颖
Di Shuting;Ye Hong;Zhou Shizhe;Ma Lidan;Ji Aichang;Cheng Xiaoyu;Liu Tian;Yang Min;Yu Yajie;Chen Ying(Department of Endocrinology and Metabolic Diseases,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;No.971 Hospital of Chinese People′s Liberation Army Navy,Qingdao 266071,China;Shangdong Provincial Key Lab of Metabolic Diseases,Qingdao 266003,China)
出处
《中华内分泌代谢杂志》
CSCD
北大核心
2023年第11期944-949,共6页
Chinese Journal of Endocrinology and Metabolism
关键词
痛风
老年人
痛风石
临床特征
Gout
Elderly patients
Tophi
Clinical features
