影响痛风患者降尿酸治疗疗效的因素分析

Analysis of factors influencing the therapeutic effect of lowering uric acid in patients with gout

目的研究影响痛风人群降尿酸治疗疗效的相关因素，建立预报降尿酸治疗疗效的非条件Logitsic回归模型。 方法分析72例痛风患者（分为未健康教育的对照组和健康教育的试验组）临床资料，测定基线期血脂、血糖、血尿酸、CRP水平和外周血NK细胞比例，关节超声评价受累关节，比较2组人群治疗24周后达标率。根据平均血尿酸水平和复发次数，将64例完整资料患者疗效（是否达标）定义为因变量，可能影响降尿酸治疗疗效的15个因素定义为自变量，建造非条件Logitsic相关分析模型，计算OR值及95%CI。 结果试验组在基线期经过专职医师健康教育后，痛风患者降尿酸治疗达标率（69%）明显高于未进行健康教育的对照组（41%，χ2=4.765，P=0.027）。回归模型显示15个自变量中进入模型的自变量有3个，依次为疾病的病程[OR=1.497，95%CI（1.179，1.901）]，有无痛风结节[OR=6.037，95%CI（1.201，30.354）]和关节B超是否异常[OR=14.484，95%CI（3.239，83.896）]。 结论在降尿酸治疗初期给予健康宣传教育，能有效提高治疗达标率。痛风患者如果具有较长的病程、多个关节受累、多发痛风结节、关节B超提示滑膜增厚则提示对降尿酸治疗应答不佳，疾病预后不良。关节超声的应用不仅有助于痛风诊断，对评估降尿酸治疗也有重要意义。

Objective To study the risk factors influencing the efficacy of uric acid therapy （ULT） in gout patients and to establish an unconditional logistic regression model to predict the efficacy of ULT. Methods Seventy-two cases of gout patients were divided into non-health education group （Group A） and the health education group （Group B） and followed up for totally 24 weeks. The clinical data were measured at baseline including blood lipid, blood glucose and serum uric acid （SUA） and C-reactive protein （CRP） level and flow eytometry determination of peripheral blood NK cell percentage and joint ultrasound examination of involved joints. Evaluation of 64 cases of patients with complete data, according to the average level of SUA and frequency of acute gout attack, the efficacy of ULT （whether treatment target achieved） was defined as the dependent variable and 15 risk factors that might affect efficacy were defined as the independent variables to establish an unconditional Logistic correlation model to calculate odds ratios （OR） and 95%CI. Results After the health education by a full-time doctor at baseline, the ULT attainment rate （69%） in Group B was significantly higher than that without health education in Group A （41%, ？（2=4.765, P=0.027）. Multiple linear regression analysis showed that there was no co-linear relationship among the variables. Regression model showed that three variables entered into the Logistic model. According to the partial regression coefficient, the three variables were as following disease duration [0R=1.497, 95%CI （1.179, 1.901）], number of tophi [OR= 6.037, 95% CI （1.201, 30.354）] and abnormal joint ultrasound [OR =14.484, 95% CI （3.239, 83.896）]. Conclusion In the early period of ULT, adequate health education can effectively improve treatment compliance and improve therapy attainment rate. Gout patients who have a longer course of disease, more joints involvement, multiple tophi and synovial thickening suggest poor response to ULT. The application of joint ultrasound is not only helpful to the diagnosis of gout, but also has important significance to evaluate the efficacy of ULT.