原发性痛风临床特点及危险因素分析

An analysis of clinical characteristics and risk factors of primary gout

目的了解原发性痛风的临床特点,分析与其相关的高危因素,为临床诊断以及预防痛风提供参考。方法回顾性分析195例初诊的原发性痛风患者的一般情况、生活方式、临床资料,以及实验室检查结果,并对原发性痛风发生的危险因素进行分析。结果 195例中,男性占97.4%(190/195),发病高峰在40～60岁(54.9%,107/195)。最常见的首发部位为第一跖趾关节,占86.2%(168/195)。单因素Logistic回归分析显示:(1)原发性痛风的发生与高嘌呤饮食相关,与吸烟、饮酒无关,若患者生活中既饮酒又吸烟,痛风发生的危险性将明显增高;(2)高体质指数(body mass index,BMI)、高血压、高血压家族史、冠心病家族史为原发性痛风的高危因素;(3)血脂组中:除载脂蛋白A(Apo-A)外,其余指标均与原发性痛风相关。三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(Apo-B)浓度的升高,高密度脂蛋白胆固醇(HDL-C)浓度的降低为痛风发病的高危因素。血清尿酸清除分数(FEuA)降低是痛风发生的独立危险因素。结论中老年男性原发性痛风的发病率较高,原发性痛风的危险因素包括:高嘌呤饮食,饮酒合并吸烟,高BMI、高血压、高血压家族史、冠心病家族史,高血脂等。中国人存在多种原发痛风的危险因素,应早期预防。

Objective To investigate the clinical features of and risk factors of primary gout so as to provide reliable data for clinical diagnosis and prophylaxis. Methods Restrospective analysis was performed in 195 newly diagnosed cases of primary gout. The data involved the general eondition, life style, clinical data and laboratory findings. Results 97.4% of the patients were male. The average age was 53 （range ：24 -72） and the peak age was between 40 -60 （54. 9% , 107/195 ）. The most vulnerable part was the first metatarsophalangeal joint （ 86.2%, 168/195 ）, followed by the ankle joint （ 6.8 %, 13/198 ） and the knee joint （ 4.8%, 8/ 198）. Conditional logistic regression analysis found that ： 1, Primary gout is only associated with high -purine diet. Patients who drink and smoke are more likely to suffer gout. 2, High Body Mass Index（BMI） ,high blood pressure （ systolic or diastolic） ,family his- tory of hypertension or coronary heart disease are closely related to primary gout. 3, In blood lipids the increased serum level of TG, TC, LDL and decreased level of HDL- C are independent risk factors of gout like fractional urate clearance（FEuA）. Conclusions Primary gout is more prevalent among middle - aged and aged people males. Risk factors may include high - purine diet, high BMI, high blood pressure （systolic or diastolic） ,family history of hypertension or of coronary heart disease, and high blood lipids. The Chi- nese should beware of these risk factors.