原发性痛风患者肾脏损害的临床特点分析

Clinical Characteristics of Renal Impairment in Patients with Primary Gout

目的:分析临床原发性痛风患者肾脏损害的发生率以及肾损害的具体表现,为防治痛风性肾病提供思路与方法。方法:回顾分析2017年1月—2018年1月在本院治疗的100例原发性痛风患者的临床资料,明确肾脏损害的发生率、临床特点,采用Pearson/Spearman相关分析研究痛风合并肾脏损害的相关危险因素。结果:100例痛风患者中,70例eGFR<90 ml/min,其中eGFR<60 ml/min达38例,34例24 h尿微量白蛋白≥30 mg,47例24 h尿蛋白定量≥0.15 g,39例肾脏B超显示肾囊肿,34例有肾结石,17例既有肾囊肿又有肾结石,有47例患者尿酸排泄不良。相关分析结果显示:痛风患者的eGFR与其痛风病程、年龄、血尿酸水平、24 h尿微量白蛋白量、24 h尿蛋白定量、24 h尿尿酸排泄分数均呈负相关,且差异有统计学意义(P<0.05)。结论:痛风患者肾脏损害的发生率高,根据发生率的高低,依次为肾功能损害、蛋白尿、肾囊肿和肾结石,并且各损害之间相互重叠,最终导致和加重患者肾功能损害。我们的研究提示,痛风患者应当早期筛查肾脏损害,力争早诊断、早干预,从而延缓患者肾功能进展。

Objective:To analyze the incidence of renal damage and the specific manifestations of renal damage in patients with primary gout, and to provide ideas and methods for the prevention and treatment of gouty nephropathy. Methods:Through retrospective analysis of the clinical data of 100 patients with primary gout who were treated in our hospital from January 2017 to January 2018, to understand the incidence and clinical characteristics of renal damage. Pearson/Spearman correlation analysis was used to study the risk factors of gout with renal damage. Results:Among 100 gout patients, 70 cases had eGFR < 90 ml/min, of which 38 cases had eGFR<60 ml/min, 34 cases had 24-hour urinary microalbumin(≥30 mg/24 h), 47 cases had 24-hour urinary protein quantification(≥0.15 g/24 h), 38 cases had renal cysts, 34 cases had renal calculi, and 17 cases had both renal cysts and renal calculi, 47 cases were poor excretion of uric acid. The results of correlation analysis showed that eGFR was negatively correlated with the course of gout, age, serum uric acid, 24-hour urinary microalbumin, 24-hour urinary protein and 24-hour uric acid excretion fraction(P<0.05). Conclusion:The incidence of kidney damage in gout patients is higher. according to the incidence, the order is renal function damage, proteinuria, renal cyst and kidney stone, and overlap each other, aggravating renal function damage.Our study suggests that gout patients should be screened for renal damage early, and strive for early diagnosis and early intervention, so as to delay the progress of renal function.