早发痛风111例临床特点与饮食饮品认知度及用药依从性的病例对照研究

A case-control study on clinical characteristics,awareness of foods&drinks and compliance of 111 early-onset gout cases

目的以病例对照方式,研究早发痛风患者的临床特点及饮食用药依从性。方法选取2018年5月至2019年4月在北京医院风湿科痛风专病门诊、全科医疗中心、北京积水潭医院风湿科及北京大学首钢医院风湿科就诊的起病年龄≤35岁的痛风患者111例为A组,选取病程匹配的起病年龄>35岁痛风患者111例为B组。比较2组患者的临床特点、急性发作诱因、平素生活习惯、饮食和用药的依从性及对疾病预防治疗认识的误区。结果A组患者肥胖(63例)、有家族史(36例)、痛风石(39例)比例高于B组(28例,20例和23例)(χ2=22.988,P<0.01;χ2=5.749,P=0.016;χ2=5.729,P=0.017),VAS评分(8.5±1.3)高于B组(7.6±1.7)(t=4.639,P<0.01),初发第一跖趾关节受累所占比例(45.9%,51例)低于B组(59.4%,66例)(χ2=4.066,P=0.044)、踝关节受累所占比例(34.2%,38例)高于B组(21.6%,24例)(χ2=4.386,P=0.036)。急性发作诱因方面A组患者在饮酒、剧烈运动以及高果糖摄入诱发比例均高于B组(χ2=6.513,P=0.011;χ2=7.126,P=0.008;χ2=1.978,P=0.160);A组患者中饮酒者及高果糖饮品摄入比例高于B组患者(χ2=8.419,P=0.004),规律运动者比例、晚餐与家庭就餐占比低于B组(χ2=22.887,P<0.01;t=-4.917,P<0.01)。A组饮食依从性不佳和用药依从性不佳所占比例(57.7%,64例)均高于B组(38.7%,43例)(χ2=5.207,P=0.022;χ2=5.867,P=0.015)。2组患者对痛风认识的主要误区差异无统计学意义(P>0.05)。结论早发痛风患者虽发病早,但病情重,饮食及用药依从性差,高果糖摄入、不恰当的剧烈运动等诱因易被忽视,临床诊治中应高度重视。

Objective To study the clinical characteristics and compliance of early-onset gout patients by case-control analysis.Methods A total of 111 early-onset patients(onset age≤35 years old)were included as Group A,and 111 non-early-onset patients(onset age>35 years old)with matched disease durationwere included as Group B.The differences ofclinical characteristics,causes of acute gout attack,dairy diet habits,compliance,and misunderstanding of the disease were compared.Results Compared with the non-early-onsetgoutpatients,the early-onset patients had a higher proportion of obesity(63 cases vs 28 cases),family history(36 cases vs 20 cases)and tophus(39 cases vs 23 cases)and higher level of VAS scores(8.5±1.3 vs 7.6±1.7;χ2=22.988,P<0.01;χ2=5.749,P=0.016;χ2=5.729,P=0.017;t=4.639,P<0.01),lowerproportionof the first metatarsophalangeal joint involvement as the initial joint involvement(45.9%,51 cases vs 59.4%,66 cases;χ2=4.066,P=0.044),higher proportion of the ankle involvement as the initial joint involvement(34.2%,38 cases vs 21.6%,24 cases;χ2=4.386,P=0.036),higher proportion of alcohol drinkers and high fructose drinkers,which was more likely to relate to alcohol intake,strenuous exercise and high fructose intakeas trigger of the flare(χ2=6.513,P=0.011;χ2=7.126,P=0.008;χ2=1.978,P=0.160),while the proportion of regular exercisers and on diet in the family was lower(χ2=22.887,P<0.01;t=-4.917,P<0.01).The proportion of poor diet and medication compliance in Group A was higher than that in Group B(57.7%,64 cases vs 38.7%,43 cases;χ2=5.207,P=0.022;χ2=5.867,P=0.015).As for the reason for poor treatment compliance,early-onset gout patients were more worry about the side-effects of drugs than non-early onset patients(χ2=4.190,P=0.041).There was no significant difference between the two groups in the main misunderstanding of gout.Conclusion Although early onset gout patients are young,their condition is more serious,and compliance is poorer,this group of patients should be highly valued in clinical diagnosis and treatment.