痛风患者达标治疗降尿酸药物剂量的影响因素分析

Analysis of Influencing Factors on the Dosage of Uric Acid Lowering Drugs for Gout Patients Undergoing Standard Treatment

目的:探究痛风患者实现达标治疗所需要的降尿酸药物用量的影响因素。方法:收集2017年6月至2018年6月在南昌大学第一附属医院风湿免疫科就诊的123例原发性痛风患者的临床资料,根据痛风患者对降尿素药物剂量的需求将其分为敏感组、次敏感组和耐药组。在达标之前2~4周随访1次,达标后1~3个月随访1次,持续1年。收集并分析不同组别患者的一般资料、个人史、合并症、实验室检查等临床资料。结果:敏感组29例(23.58%),次敏感组44例(35.77%),耐药组50例(40.65%);单因素分析显示,病程、年龄、体质量指数(BMI)、家族史、初始血肌酐值、初始红细胞沉降率、糖尿病、脑卒中与痛风患者的达标治疗相关(P <0.05)。多因素分析结果显示,BMI、初始血肌酐值和家族史是痛风达标治疗的独立影响因素(P <0.05)。结论:存在高BMI、家族中有痛风史以及高血肌酐的痛风患者对现有的降尿酸药物反应较差,临床中需兼顾痛风患者BMI及血肌酐的管理,个体化制定降尿酸药物剂量,做到精准化达标治疗。

Objective:To explore the influencing factors of the dosage of uric acid lowering drugs required for gout patients to achieve standard treatment.Methods:Clinical data of 123 patients with primary gout who had visited the Department of Rheumatology and Immunology at the First Affiliated Hospital of Nanchang University from June 2017 to June 2018 were collected.Gout patients were divided into a sensitive group,a sub sensitive group,and a drug resistant group based on their demand for the dosage of urea lowering drugs.Follow up once 2~4 weeks before reaching the standard,and once 1~3 months after reaching the standard,lasting for 1 year.General information,personal history,comorbidities,laboratory tests,and other clinical characteristics of patients in different groups were collected and analyzed.Results:There were 29 cases(23.58%)in the sensitive group,44 cases(35.77%)in the sub sensitive group,and 50 cases(40.65%)in the drug resistant group.Univariate analysis showed that the course of disease,age,body mass index(BMI),family history,initial blood creatinine value,initial erythrocyte sedimentation rate,diabetes and stroke were related to the standard treatment of gout patients(P<0.05).Multivariate analysis showed that BMI,initial blood creatinine value and family history were independent influencing factors for gout treatment(P<0.05).Conclusion:Gout patients with high BMI,a family history of gout,and high blood creatinine have poor response to existing uric acid lowering drugs.In clinical practice,it is necessary to balance the management of BMI and blood creatinine in gout patients,and tailor the dosage of uric acid lowering drugs to achieve precise and standardized treatment.