尿酸盐晶体沉积痛风住院患者临床特征及相关危险因素分析

Analysis of clinical characteristics and risk factors for the deposition of urate crystal in patients with gout

目的探讨住院痛风患者尿酸盐晶体沉积组和非尿酸盐晶体沉积组各临床资料的差异,并探讨尿酸盐晶体沉积的相关危险因素,为尿酸盐晶体沉积的早期防治提供临床依据。方法回顾性分析2017年6月~2019年6月在风湿免疫科住院痛风患者共116例,根据双能CT结果分成尿酸盐晶体沉积组和非尿酸盐晶体沉积组,比较两组临床资料是否存在差异,采用多因素Logistic回归分析痛风患者发生尿酸盐晶体沉积的危险因素。结果住院痛风患者出现尿酸盐晶体沉积比率为54.31%,尿酸盐晶体沉积患者较非尿酸盐晶体沉积患者痛风病程长(55.25个月vs.33.53个月,P=0.011),有更高的天门冬氨酸氨基转移酶(AST)、肌酐(Cr)、尿素氮(BUN)水平更高[(26.40±17.23)U/L vs.(20.25±12.31)U/L,P=0.0318;(112.1±72.85)μmol/L vs.(88.48±18.39)μmol/L,P=0.0236;(6.019±4.076)mmol/L vs.(4.649±1.658)mmol/L,P=0.0238],而在年龄、尿酸水平、血脂水平、伴发疾病(高血压病、糖尿病、脂肪肝、肾结石、冠心病、脑梗死)发生率指标上差异无统计学意义。应用多因素Logistic回归分析发现,病程(OR:1.015,95%CI:1.005~1.025,P=0.003)、Cr(OR:1.019,95%CI:1.003~1.036,P=0.021)、BUN(OR:1.27,95%CI:1.033~1.561,P=0.023)均为住院痛风患者发生尿酸盐晶体沉积的危险因素,而病程是住院痛风患者发生尿酸盐沉积的独立危险因素。结论住院痛风患者有肾功能损害者更容易出现尿酸盐晶体沉积,而病程则为尿酸盐晶体沉积的独立危险因素,随着痛风病程的延长,更要注意防范尿酸盐晶体沉积的发生。

Objective To investigate the difference of clinical data between uric acid crystal deposition group and non uric acid crystal deposition group in inpatients with gout and to explore the risk factors of urate crystal deposition,so as to provide clinical basis for the early prevention and treatment of urate crystal deposition.Methods From June 2017 to June 2019,116 inpatients suffered from gout from department of rheumatology and clinical immunology in Tungwah Hospital of Sun Yat-sen University were enrolled in a retrospective analysis.The patients were divided into uric acid crystal deposition group and non uric acid crystal deposition group according to the results of dual energy CT.To compare the clinical data of the two groups,multivariate Logistic regression was used to analyze the risk factors for urate crystal deposition in patients with gout.Results The deposition of urate crystal occurred in 54.31%of inpatients with gout.Compared with the inpatients without urate crystal deposition,the inpatients with urate crystal deposition had longer course of gout(55.25 months vs.33.53 months,P<0.01),and the higher level of aminotransferase(AST),creatinine(Cr)and blood urea nitrogen(BUN)respectively[(26.40±17.23)U/L vs.(20.25±12.31)U/L,P=0.0318,(112.1±72.85)μmol/L vs.(88.48±18.39)μmol/L,P=0.0236,(6.019±4.076)mmol/L vs.(4.649±1.658)mmol/L,P=0.0238),while the age,the level of uric acid or lipid,the incidence of concomitant diseases(hypertension,diabetes,fatty liver,kidney stones,coronary heart disease,cerebral infarction),showed no significant difference between this two groups.The univariate Logistic regression analysis showed that course of gout(OR:1.015,95%CI:1.005~1.025,P=0.003),Cr(OR:1.019,95%CI:1.003~1.036,P=0.021)and BUN(OR:1.27,95%CI:1.033~1.561,P=0.023)were the risk factors of urate crystal deposition in inpatients with gout,while only the course of gout(OR:1.013,95%CI:1.003~1.022,P=0.01)was the independent risk factor.Conclusion The inpatients with renal impairment in gout were more likely to have crystal deposition of urate,and the course of disease was an independent risk factor for crystal deposition of urate.With the prolongation of the course of gout,more attention should be paid to prevent the occurrence of crystal deposition of urate.