893例青年痛风患者临床特点和随访分析

Clinical characteristics and follow-up analysis of 893 young gout patients

目的分析893例青年痛风患者临床特点和随访情况。方法将本院2010年5月至2018年5月收治的893例青年痛风患者纳入青年组,并选取本院同期500例中老年痛风患者纳入中老年组。比较两组患者一般情况、临床症状、发病诱因、相关指标(收缩压、舒张压、空腹血糖、血脂、血尿素氮等)、治疗情况和随访率,总结青年痛风患者的临床特点和随访情况。结果青年组共有2916次发病诱因明确,中老年组共有1320次发病诱因明确。青年组男性、有痛风家族史、嗜酒、高嘌呤饮食、摄入高嘌呤/高蛋白食物、饮酒所致痛风发作的患者占比、血清肌酐/血尿酸(serum uric acid,SUA)水平、肾小球滤过率均显著高于中老年组(均P < 0.05),高血压/糖尿病/冠心病患病率、劳累/情绪激动/受凉/应用利尿剂等药物所致痛风发作的次数、初诊时收缩压/舒张压、空腹血糖/甘油三酯/血尿素氮水平均显著低于中老年组(均P < 0.05),痛风发作次数、累及关节或部位、多次发作累及关节数均显著多于中老年组(均P < 0.05),发作持续时间显著短于中老年组(P < 0.05)。两组患者治疗4、12、24周时随访率均逐渐下降(均P < 0.05),SUA达标率均逐渐上升(均P < 0.05),青年组患者各时点随访率均显著低于同期中老年组(均P < 0.05),两组患者各时点SUA达标率比较差异均无统计学意义(均P > 0.05)。结论青年痛风患者的临床特点与中老年患者存在较大差异,青年患者基础疾病较少,但酗酒、高嘌呤/高蛋白食物的摄入使痛风发作频率更高、累及关节和部位更多,且患者治疗依从性往往较低,应重视针对青年痛风患者的规范化诊治。

Objective To analyze the clinical characteristics and follow-up of 893 young gout patients. Method A total of 893 young gout patients admitted to our hospital from May 2010 to May 2018 were enrolled in youth group, and 500 middle-aged and elderly gout patients during the same period were enrolled in middle-aged and elderly group. The general conditions, clinical symptoms, pathogenic factors and related indicators (systolic blood pressure, diastolic blood pressure, fasting blood sugar, blood lipid, blood urea nitrogen, etc.) of the two groups were compared, and the treatment and follow-up rates of the two groups were compared. The clinical characteristics and follow-up of young gout patients were summarized. Result A total of 2916 incidents were identified in youth group and 1320 in middle-aged and elderly group. The proportion of patients with males, family history of gout, alcoholism, high purine diet and intake of high purine/high protein food, gout attack caused by drinking and the levels of serum creatinine, serum uric acid (SUA), glomerular filtration rate were significantly higher than those in middle-aged and elderly group (all P < 0.05). The incidence of hypertension, diabetes mellitus, coronary heart disease and gout attack caused by fatigue/emotional agitation, cold, diuretics and other drugs, and the systolic blood pressure, diastolic blood pressure, fasting blood sugar, triglyceride and blood urea nitrogen levels at first diagnosis were significantly lower than those in middle-aged and elderly group (all P < 0.05), and the frequency of gout attacks, the involvement of joints or sites were significantly lower than those in middle-aged and old-aged groups (all P < 0.05). The number of joints involved in multiple seizures was significantly higher in middle-aged and elderly groups (all P < 0.05), and the duration of seizures was significantly shorter in middle-aged and elderly group (P < 0.05). The follow-up rate of the two groups decreased gradually at 4, 12 and 24 weeks after treatment (all P < 0.05), and the SUA compliance rate increased gradually (all P < 0.05). The follow-up rate of youth group at all time points was lower than that of middle-aged and elderly group (all P < 0.05). There were no significant differences in SUA compliance rates between the two groups at different time points (all P > 0.05). Conclusion The clinical characteristics of young patients with gout are quite different from those of middle-aged and elderly patients. There are fewer basic diseases in young patients. However, alcohol abuse and high purine/high protein food intake make the incidence of gout more frequent, involving more joints and parts, and the treatment compliance of young patients is often low. We should pay attention to the standardized diagnosis and treatment of the clinical characteristics of young patients with gout.