难治性痛风中医证候特点与影响因素分析

Analysis of Traditional Chinese Medicine Syndromes Characteristics and Influencing Factors of Refractory Gout

目的:探讨难治性痛风(RG)的影响因素及中医证候特点,为难治性痛风防治提供可靠临床依据。方法:收集2021年1月-2022年6月北京中医药大学东直门医院通州院区肾病内分泌门诊及痛风(GA)门诊就诊的199名痛风患者的临床资料,分为RG患者46例、非RG患者153例,分析RG患者中医证候特点及发病影响因素。结果:两组患者阳虚、气滞、湿热、痰湿、血虚证候组间比较,差异均无统计学意义(P>0.05);难治性痛风组患者气虚证、阴虚证、血瘀证占比更高,与非难治性痛风组比较,差异具有统计学意义(P<0.05)。两组患者在性别分布、糖尿病和高脂血症占比及低密度脂蛋白、总胆固醇、甘油三酯组间比较,差异均无统计学意义(P>0.05);RG患者高血压、脑梗死占比更高,且年龄、血肌酐、血尿酸、尿素明显高于非RG组,而高密度脂蛋白明显低于非RG组,差异具有统计学意义(P<0.05)。单因素二元Logistic回归分析提示,高血压、脑梗死、血瘀证、阴虚证以及年龄、血肌酐、尿素、血尿酸、高密度脂蛋白是RG的影响因素;多因素二元Logistic回归分析提示,阴虚证、血瘀证、高血压、血尿酸是RG的独立风险因素。结论:RG患者年龄更高,合并症较多,阴虚证和血瘀证是RG发病的关键病机,有高血压病史和更高的血尿酸水平也与RG的发病密切相关。

Objective:To explore the influencing factors and Chinese medicine evidence characteristics of refractory gout(RG),and to provide a reliable clinical basis for the prevention and treatment of refractory gout.Methods:Clinical data of 199 gout patients attending the nephrology endocrine clinic and gout(GA) clinic of Tongzhou district,Dongzhimen Hospital Beijing University of Chinese Medicine were collected from January 2021 to June 2022,which were classified into 46 cases of RG patients and 153 cases of non-RG patients,to analyze the characteristics of Chinese medicine syndromes and the pathogenic influences in the RG patients.Results:Intergroup comparisons of the proportion of Yang deficiency,Qi stagnation,damp-heat,phlegm-dampness,and blood deficiency symptoms in the two groups were not statistically significant(P>0.05);the proportion of Qi deficiency symptoms,Yin deficiency symptoms,and blood stasis symptoms in the patients of the refractory gout group was higher,and compared with that of the non-refractory gout group,the difference was statistically significant(P<0.05).The differences between the two groups were not statistically significant in gender distribution,percentage of diabetes mellitus and hyperlipidemia,and between-group comparisons of LDL,total cholesterol,and triglycerides(P>0.05);RG patients had a higher percentage of hypertension and cerebral infarction,and their age,blood creatinine,blood uric acid,and urea were significantly higher than those in the non-RG group,whereas HDL was significantly lower than those in the non-RG group,and the differences were statistically significant(P<0.05).Univariate binary logistic regression analysis suggested that the presence of hypertension,cerebral infarction,the presence of blood stasis evidence,yin deficiency evidence,as well as age,blood creatinine,urea,blood uric acid,and high-density lipoprotein were the influencing factors of RG;and multifactorial binary logistic regression analysis suggested that the presence of yin deficiency evidence,the presence of blood stasis evidence,the presence of hypertension,and blood uric acid were the independent risk factors of RG.Conclusion:Patients with RG were older and had more comorbidities,Yin deficiency and blood stasis were the key pathogenetic factors in the development of RG,and a history of hypertension and higher blood uric acid levels were also closely associated with the development of RG.