强直性脊柱炎伴高尿酸血症的临床特征分析

Analysis of clinical characteristics of ankylosing spondylitis with hyperuricemia

目的比较强直性脊柱炎(Ankylosing spondylitis,AS)合并高尿酸血症(Hyperuricemia,HUA)患者与不合并HUA的差异,分析其临床特征。方法采用回顾性研究的方法,调查于2016年1月1日至2017年6月30日在中日友好医院中医风湿病科住院的AS患者共285例,收集临床资料,根据尿酸水平分为两组:高尿酸组为AS伴HUA患者(50例),对照组为AS不伴HUA患者(235例);中医证候分型根据AS证候标准和病程记录分为肾虚督寒证和肾虚湿热证;运用SPSS 17.0软件统计分析。结果285例患者中,高尿酸组的男性所占比例大于对照组,发病年龄早于对照组,平均年龄小于对照组,晨僵时间小于对照组,体重指数(Body Mass Index,BMI)高于对照组(P<0.05);两组起病病程、确诊病程、骶髂关节炎CT分级、ACR关节功能分级、人白细胞抗原-B27(Human leukocyte antigen-B27,HLA-B27)基因及亚型、空腹血糖、红细胞沉降率(Erythrocyte sedimentation,ESR)、C-反应蛋白(C-reactiveprotein,CRP)比较,差异无统计学意义(P>0.05);高尿酸组白细胞(WBC)、红细胞(RBC)、血红蛋白(HGB)、尿pH值、肌酐、总胆固醇、甘油三酯、低密度脂蛋白水平明显高于对照组,高密度脂蛋白水平明显低于对照组,合并血脂异常、高血压、脂肪肝多于对照组,肾虚湿热证型明显多于对照组(P<0.05);男性AS患者合并HUA的风险是女性AS患者的14.21倍(P<0.05);肾虚湿热证AS患者合并HUA的风险是肾虚督寒证AS患者的2.53倍(P<0.05)。结论AS伴HUA患者中,男性居多,发病年龄小,存在BMI值增高、血脂异常等代谢综合征倾向,合并血脂异常、脂肪肝、高血压的比例较AS不伴HUA患者高,临床应重视AS合并HUA患者的体重、尿酸和血脂管理;AS伴HUA患者中医证候以肾虚湿热证为主,治疗上应注重补肾清热,利湿去浊。

Objective To analyze the clinical characteristics of patients with ankylosing spondylitis(AS)with hyperuricemia(HUA)and to compare the difference between AS patients with HUA and without HUA.Methods In this a retrospective study,285 AS patients admitted from Jan 1,2016 to June 30,2017 in the TCM Rheumatology Department of China-Japan Friendship Hospital were divided into the HUA group(AS with HUA,n=50)and the control group(AS without HUA,n=235)and clinical data was collected.TCM syndrome differentiation is made to kidney deficiency with Du-meridian cold syndrome and kidney deficiency with damp heat syndrome according to the standard of AS syndrome and the record of disease course.SPSS17.0 software was used for statistical analysis.Results In all the 285 cases,compared with the control group,the HUA group had a greater proportion of male patients,earlier onset age,younger average age,less morning stiffness time and higher BMI(P<0.05);and there was no significance in onset course,confirmed diagnosis time,AS CT grade,ACR joint function grade,HLA-B27 gene and subtype,fasting blood-glucose,ESR and CRP in the two groups(P>0.05);WBC,RBC,HGB,U-pH,CR,TC,TG,LDL in the HUA group were significantly higher than the control group,and the HDL levels were significantly lower than the control group;the ratio of patients combined with dyslipidemia,hypertension,hepatic adipose infiltration were larger than control group;patients with kidney deficiency and damp heat was higher in the treatment group than that in the control group(P<0.05).The risk of HUA in male AS patients was 14.21 times as high as that of female AS patients(P<0.05);the risk of HUA in AS patients with kidney deficiency and damp heat was 2.53 times as high as that in AS patients with kidney deficiency and Du-meridian cold(P<0.05).Conclusion AS patients with HUA is more common in males,at a younger age,with higher BMI and metabolic syndrome,and higher incidence of dyslipidemia,fatty liver and hypertension compared with the patients without HUA.Attention should be paid to weight,uric acid,blood lipid of the patients with AS and HUA.Kidney deficiency with damp heat is the main syndrome differentiated by TCM,therefore,treatment should be focused on tonifying kidney,clearing heat,eliminating dampness and turbid.