462例痛风患者合并症或并发症及其相关因素研究

Study on Comorbidities or Complications and Related Factors of 462 Patients with Gout

目的:调查痛风患者合并症或并发症的临床特点并分析痛风中医证型与其合并症或并发症的相关性。方法:回顾性分析浙江中医药大学附属第二医院风湿科痛风患者的合并症或并发症,分析年龄、中医证型等与合并症或并发症的相关性。结果:共收集痛风病例462例,有402例痛风患者合并或并发其他疾病,总发生率87.01%。痛风最常见的合并症或并发症排前5位者依次为高血压(54.2%)、高血脂(33.6%)、肾功能不全(29.4%)、肾结石/结晶(14.7%)、肝功能不全(12.2%)。对高血压、高血脂、肾功能不全、肾结石/结晶、肝功能不全进行影响因素的多元回归分析获得:影响痛风患者高血压发生的因素为年龄和低密度脂蛋白(LDL),高血脂发生的因素为血沉(ESR)、低密度脂蛋白(LDL)、总胆固醇(TC)和血糖(GLU),肾功能不全发生的因素为性别、血小板、血尿酸和ESR,肾结石/结晶以及肝功能不全发生的因素分别为病程和年龄。高血压是发病率最高的合并症,各证型包括湿热蕴结、肝肾阴虚、痰浊阻滞、瘀热阻滞痛风患者合并高血压发生率比较,差异无统计学意义(P>0.05)。合并高血脂或肾囊肿的痛风患者,均以湿热蕴结型最多见,各证型合并病发生率比较,差异均有统计学意义(P<0.05);合并心律失常患者中,痰浊阻滞型和肝肾阴虚型发生率高,各种型合并心律失常发生率比较,差异均有统计学意义(P<0.05)。结论:痛风患者常出现合并症或并发症,以心血管疾病及肾脏疾病多见,男性、高龄、长病程,以及血沉是其重要的危险因素。

Objective:To investigate the clinical characteristics of comorbidities or complications of gout patients and analyze the correlation between Chinese medicine syndromes of gout and their comorbidities or complications.Methods:The comorbidities or complications of gout in the Rheumatism Department of the Second Affiliated Hospital of Zhejiang Chinese Medical University were retrospectively analyzed,and the correlation between age,Chinese medicine syndrome types and comorbidities or complications was analyzed.Results:A total of 462 cases with gout were collected,and 402 gout patients were complicated with other diseases,with a total incidence of 87.01%.The top five most common comorbidities or complications of gout were hypertension(54.2%),hyperlipidemia(33.6%),renal insufficiency(29.4%),kidney stones or crystallization(14.7%)and liver insufficiency(12.2%).Multiple regression analysis of influencing factors for hypertension,hyperlipidemia,renal insufficiency,kidney stones or crystallization,and liver insufficiency was obtained:The factors influencing the occurrence of hypertension in patients with gout were age and low density lipoprotein(LDL),the factors influencing the occurrence of hyperlipidemia were erythrocyte sedimentation rate(ESR),low density lipoprotein(LDL),total cholesterol(TC)and blood glucose(GLU),and the factors influencing the occurrence of renal insufficiency were gender,platelet,blood uric acid and ESR,and factors contributing to the occurrence of kidney stones or crystallization and liver insufficiency were disease course and age,respectively.Hypertension was the comorbidity with the highest incidence,and there was no significant difference in the incidence of hypertension among gout patients of damp-heat accumulation type,liver-kidney yin deficiency type,turbid phlegm obstruction and stagnation type,and static heat obstruction and stagnation type(P>0.05).In patients with gout complicated with hyperlipidemia or renal cyst,the damp-heat accumulation type was the most common type,and there were significant differences in the incidence of hyperlipidemia or renal cyst among all syndrome types(P<0.05).The incidence of arrhythmia was high in patients of the turbid phlegm obstruction and stagnation type and the liver-kidney yin deficiency type,and there was significant difference in the comparison of the incidence of arrhythmia among each syndrome types(P<0.05).Conclusion:The patients with gout often have comorbidities or complications,such as cardiovascular diseases and kidney diseases.Male,old age,long course of disease and erythrocyte sedimentation rate are the important risk factors.