尿酸排泄分数与原发性痛风的相关性研究

Correlation study between fractional excretion of uric acid and primary gout

目的探讨尿酸排泄分数与原发性痛风患者血尿酸、体质量指数（BMI）、血压、血糖以及血脂等代谢因素的相关性。方法选择62例原发性痛风患者为痛风组和32例健康体检者为对照组，痛风组患者按尿酸排泄分数水平分为尿酸排泄减少组29例（尿酸排泄分数〈7％）、混合组25例（7％≤尿酸排泄分数≤12％）和尿酸生成增多组8例（尿酸排泄分数〉12％）。抽取患者空腹血，检测血肌酐、血尿酸、血糖、糖化血红蛋白及血脂水平，留取24h尿，测得24h尿尿酸、尿肌酐，根据公式计算尿酸排泄分数并进行相关性分析。结果痛风组BMI、平均动脉压、血尿酸、糖化血红蛋白、总胆固醇、餐后2h血糖明显高于对照组，高密度脂蛋白胆固醇、尿酸排泄分数明显低于对照组，差异有统计学意义（P〈0．05）；两组年龄、空腹血糖、低密度脂蛋白胆固醇、三酰甘油比较差异无统计学意义（P〉0．05）。尿酸排泄减少组、混合组、尿酸生成增多组年龄、血尿酸、空腹血糖、餐后2h血糖、糖化血红蛋白、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇比较差异无统计学意义（P〉0．05）；三组BMI、平均动脉压、三酰甘油、尿酸排泄分数比较差异有统计学意义（P〈0．05）。对照组和痛风组，尿酸排泄分数与血尿酸均呈负相关（r=一3．900，一0．476，P〈0．05）。痛风组尿酸排泄分数与24h尿尿酸呈正相关（r=0．465，P=0．001），与三酰甘油水平呈负相关（r=一0．304，P〈0．05）。痛风组Pearson相关分析显示尿酸排泄减少组（尿酸排泄分数〈7％）尿酸排泄分数与血尿酸呈负相关（r=一0．392，P〈0．05），非尿酸排泄减少组（尿酸排泄分数≥7％）尿酸排泄分数与血尿酸呈正相关（r=0．437，P〈0．05），而24h尿尿酸与血尿酸无相关性（P〉0．05）。多元logistic回归分析提示血尿酸、糖化血红蛋白、尿酸排泄分数为痛风发病危险因素（P〈0．05）。结论原发性痛风患者除了血尿酸的明显变化外，还存在血压、血糖和血脂的明显变化，尿酸排泄分数可作为评价原发性痛风患者尿酸排泄能力的指标；平均动脉压、糖化血红蛋白、尿酸排泄分数为痛风发病危险因素。

Objective To study the correlation between fractional excretion of uric acid （FEUA） and blood uric acid, body mass index （BMI）, blood pressure, blood glucose, blood lipid and other metabolic factors in patients with primary gout. Methods Sixty-two patients with primary gout （gout group） and 32 healthy people （control group） were selected in this study. Gout group was divided into uric acid excretion decreasing group （FEUA 〈 7% ,29 cases）,mixed group （7% ≤FEUA ≤12%, 25 cases） and uric acid production increasing group （FEUA 〉 12%, 8 cases） according to the level of FEUA. The fasting blood glucose （ FPG ）, 2-hour postprandial blood glucose （ 2 h PBG）, blood lipid, serum creatinine, blood uric acid,glycosylated hemoglobin were tested. 24 hours urine was collected and urinary uric acid and urinary creatinine was measured, FEUA was calculated and analyzed. Results BMI, mean arterial pressure, blood uric acid, glycosylated hemoglobin, total cholesterol, 2 h PBG in gout group was higher than that in control group, and high density tipoprotein cholesterol, FEUA was lower than that in control group, and there was significant difference （P 〈 0.05）. There was no significant difference in age, FPG, low density lipoprotein cholesterol, triacylglycerol between two groups （P 〉 0.05 ）. There was no significant difference in age, blood uric acid, FPG, 2 h PBG, glycosylated hemoglobin,total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol among uric acid excretion decreasing group, mixed group and uric acid production increasing group （P 〉 0.05 ）, and there was significant difference in BMI, mean arterial pressure, triacylglycerol, FEUA among three groups（P 〈 0.05 ）. FEUA was negatively correlated with blood uric acid in control group and gout group （r =-3.900,-0.476,P 〈 0.05）. FEUA was positively correlated with 24 h urinary uric acid in gout group （r = 0.465 ,P = 0.001 ）, and nagatively correlated with triacylglycerol （r = -0.304, P 〈 0.05 ）. Pearson analysis showed that FEUA was negatively correlated with blood uric acid in uric acid excretion decreasing group （FEUA 〈 7% ）（r = -0.392, P 〈 0.05 ）, FEUA was positively correlated with blood uric acid in non uric acid excretion decreasing group （FEUA≥ 7% ）（r = 0.437, P 〈 0.05 ）, but 24 h urinary uric acid was not correlated with blood uric acid（P 〉 0.05 ）. Multi-stepwise regression analysis showed that blood uric acid, glycosylated hemoglobin, FEUA was significantly correlated with the onset of the gout （P 〈 0.05）. Conclusions Besides blood uric acid level,there are significant changes in primary gout in blood pressure, serum glucose and lipid levels. FEUA could be used to estimate the ability of renal excrete the uric acid. Mean arterial pressure, glycosylated hemoglobin and FEUA are the risk factors for gout.