痛风患者术后急性复发的危险因素分析

Analysis of risk factors for postoperative acute recurrence in patients with gout

目的:探讨痛风患者术后急性复发的危险因素。方法:回顾性分析2010年1月至2018年1月汕头大学医学院第一附属医院368例有既往痛风病史的手术患者的临床资料。根据有无术后急性痛风复发分为复发组和未复发组,比较2组患者一般临床特征、手术因素和用药情况。采用多因素Logistic回归分析术后急性痛风复发的危险因素。结果:复发组患者术前血尿酸水平、术后血尿酸降低水平、腹腔手术比例和术后完全肠外营养的使用率均高于未复发组(P<0.05),术前秋水仙碱预防使用率低于未复发组(P<0.05)。多因素Logistic回归分析显示,术后血尿酸降低水平、腹腔手术、术前未预防性使用秋水仙碱和术后完全肠外营养的使用是术后急性痛风复发的危险因素。结论:对于既往痛风患者,尤其是进行腹腔手术患者,术后及时监测血尿酸,预防性使用秋水仙碱和减少术后完全肠外营养的使用有助于降低术后痛风复发风险。

Objective: To explore the risk factors of postoperative acute recurrence in patients with gout. Methods:We retrospectively analyzed the clinical data of 368 surgical patients with a history of gout in the First Affiliated Hospital of Shantou University Medical College from January 2010 to January 2018. According to the recurrence of acute gout after operation, the patients were divided into recurrence group and nonrecurrence group. The general clinical features,surgical factors and drug use were compared between the two groups. Multivariate logistic regression analysis was used to analyze the risk factors of postoperative acute gout recurrence. Results: The preoperative blood uric acid level, postoperative blood uric acid reduction, abdominal surgery rate and total postoperative parenteral nutrition were higher in the recurrent group than in the non- recurrent group (P<0.05). The preoperative colchicine prophylaxis rate was lower in the recurrent group than in the non- recurrent group(P<0.05). Multivariate logistic regression analysis showed that postoperative blood uric acid reduction, abdominal surgery, preoperative non- prophylactic use of colchicine and postoperative complete parenteral nutrition were risk factors for postoperative acute gout recurrence. Conclusions: For patients with previous gout, especially those undergoing abdominal surgery, timely monitoring of blood uric acid after surgery,prophylactic use of colchicine and reduction of postoperative total parenteral nutrition can help reduce the risk of postoperative gout recurrence.