应用受试者工作特征曲线分析血尿酸联合血脂四项检测对痛风的诊断价值

Diagnostic value of serum uric acid level combined with four-item blood lipids test panel in gout patients:a receiver operating characteristic curve analysis

目的对比分析本地区痛风组、对照组和体检人群血尿酸和血脂的检测结果,探讨两者在痛风诊断中的临床价值及本地区的痛风流行病学状况。方法选择2019年在汕尾市人民医院门急诊就诊、主要诊断为痛风的患者90例为观察组和健康体检者90名为对照组,收集2组研究对象的血尿酸、胆固醇、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)的检测结果,分析观察组血脂四项与血尿酸的相关性,并采用受试者工作特征(ROC)曲线分析血尿酸对于痛风的诊断界值;并对照分析本地区体检人群血尿酸达到痛风诊断界值的比例。结果观察组和对照组尿酸分别为(490±130)μmol/L和(320±57)μmol/L,差异有统计学意义(P<0.05);观察组与对照组的胆固醇、TG和LDL-C对比差异有统计学意义(P<0.05),而HDL-C对比差异无统计学意义(P=0.234);观察组男性和女性患者尿酸分别为(536±120)μmol/L和(400±102)μmol/L,对比差异有统计学意义(P<0.05);Pearson相关性分析可见观察组胆固醇、HDL-C与尿酸呈弱负相关,TG、LDL-C与尿酸存在弱相关。ROC曲线分析男性和女性尿酸对于痛风的诊断界值分别为423.0μmol/L和354.5μmol/L;汕尾市城区体检人群中男性尿酸达到以上痛风诊断界值比例为42.89%,女性比例为20.24%。结论对照分析痛风组、对照组及体检人群的血尿酸和血脂检测结果,显示本地区体检人群血尿酸超过痛风诊断界值比例高,在体检人群中加强血尿酸监测非常重要;血尿酸对于痛风具有较高的诊断效能,总胆固醇、TG和LDL-C可作为辅助诊断指标。

Objective To compare the testing results of serum uric acid(UA)and lipids in gout pa-tients,healthy controls and a large group of health checkup subjects from a regional population,so as to explore the clinical value of blood UA and lipids testing in diagnosing gout,along with the epidemiology of gout in the study region.Methods Included as the study group were 90 patients with a primary diagnosis of gout registered to our outpatient clinic or emergency department in 2019,with 90 health checkup subjects during the same year as the control group.The test results of serum UA,cholesterol(CH),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)of the two groups were retrieved.The cor-relation between findings of the four-item blood lipids test panel and serum UA was analyzed.Receiver operating characteristic(ROC)curve analysis was performed to obtain the cut-off value of serum UA in diagnosing gout.In addition,we investigated in a large group of health checkup subjects from the study region for the proportion of those whose serum UA levels were eligible for a diagnosis of gout with this cut-off value.Results The serum UA level was(490±130)μmol/L in the study group vs(320±57)μmol/L in the control group,with statistically significant difference(P<0.05).The study and control groups differed statistically in the levels of CH,TG and LDL-C(P<0.05),but not for HDL-C(P=0.234).In the study group,significant difference between males and females was found in serum UA levels[(536±120)μmol/L vs(400±102)μmol/L,P<0.05],In the study group,Pearson′s correlation analysis showed that CH and HDL-C were in weak negative correlations,and TG and LDL-C were in weak correlations,with serum UA.ROC curve analysis showed that the cut-off values of serum UA for diagnosing gout was 423.0μmol/L in males and 354.5μmol/L in females,respectively.Among the health checkup subjects from urban Shanwei,42.89%of the males and 20.24%of the females presented serum UA levels up to or above the cut-off value for a diagnosis of gout.Conclusion Comparisons on the results of serum UA and blood lipids across gout patients,healthy controls and a large group of health check-up subject revealed a high proportion of elevated serum UA exceeding the diagnostic cut-off value for gout among health check-up population in the study region,underlining the importance to strengthen serum UA monitoring in health check-ups.While serum UA level offers high diagnostic performance for gout,total CH,TG,and LDL-C choles-terol can also be useful indicators to help determining a diagnosis.