山东省痛风年轻化趋势及相关危险因素分析

Analysis on the trend of early-onset gout and related risk factors in Shandong Province

目的探讨山东省痛风年轻化趋势及相关危险因素,为遏制痛风年轻化现象提供决策资料。方法通过电子病历结合与患者面对面交流方式,收集2016年9月至2021年12月首次就诊于青岛大学附属医院痛风专病门诊的8393例痛风患者的基线资料、伴发病情况、生化检查和首次发病时间,统计分析2002年至2021年期间发病年龄的动态变化,并统计分析早发型和晚发型痛风患者临床特征及相关危险因素。结果2002年至2021年期间痛风发病年龄呈明显下降趋势,与2002年相比,2021年平均发病年龄下降了2.3岁[(41.9±10.6对39.6±14.0)岁,P=0.042]。2012年至2021年与2002年至2011年相比,发病年龄中位数减小了3岁(37对40岁,P<0.001)。发病年龄<40岁的痛风患者构成比明显上升,由2002年的45.1%上升到57.8%,20年间增加了12.7%(P<0.001)。20~29岁组(P趋势<0.001)和≤19岁组(P趋势=0.011)构成比逐年上升,20年期间分别增加了9.3%(P<0.001)和4.2%(P=0.002),是发病年龄<40岁各年龄段增幅最高者。多元逐步线性回归分析结果显示阳性家族史、血尿酸水平、合并代谢综合征以及吸烟是痛风早发的独立危险因素。结论山东省痛风呈现明显年轻化现象,发病年龄<30岁患者所占比例的明显增加,可能是导致痛风年轻化现象的关键因素。对早发型痛风相关危险因素进行早期和有效干预,是遏制痛风年轻化现象、降低痛风及其相关合并症患病率的关键所在。

Objective To explore early-onset gout and related risk factors in Shandong Province,and provide decision-making information on prevention.Methods Data from electronic medical records and face-to face interview were collected from 8393 patients with gout who first visited the gout clinic of the Affiliated Hospital of Qingdao University from September 2016 to December 2021.Data included demographics,comorbidity and biochemical examinations.The dynamic changes of onset age from 2002 to 2021 were statistically analyzed.The clinical characteristics and related risk factors of patients with early-onset and late-onset gout were statistically analyzed.Results The age of onset of gout decreased significantly from 2002 to 2021.Compared with 2002,the average age of onset in 2021 decreased by 2.3 years[(41.9±10.6 vs 39.6±14.0)years].The median age of onset decreased by 3 years in 2012-2021 compared with 2002-2011(37 vs 40 years,P<0.001).The proportion of gout patients with onset age<40 years old increased significantly,from 45.1%in 2002 to 57.8%,and increased by 12.7%in 20 years(P<0.001).The constituent ratios of 20-29 years old group(Ptrend<0.001)and≤19 years old group(Ptrend=0.011)increased by 9.3%(P<0.001)and 4.2%(P=0.002)over 20 years,which was the highest increase among all age groups with onset age<40 years old.Multivariate stepwise linear regression analysis showed that positive family history,blood uric acid level,metabolic syndrome and smoking were independent risk factors for early onset of gout.Conclusion The age of gout onset in tends to be younger.The increase of the proportion of patients younger than 30 years old is probably the key factor leading to the early-onset gout in Shandong Province.Early and effective intervention on the risk factors related to early-onset gout is essential to prevent the early-onset gout as well as to reduce the prevalence of gout and complications.