高尿酸血症发生痛风的相关危险因素研究
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摘要
目的探讨影响成年人群高尿酸血症(HUA)者发生痛风的危险因素,为痛风源头预防提供科学依据。方法采用1∶1配对病例对照研究的方法,从2015—2016年广西痛风流行病学调查研究病例中,选出痛风患者129人作为病例组,以同性别、同民族、年龄相差±3岁、同乡镇的单纯高尿酸血症者129人作为对照组;调查收集两组人群一般情况、行为习惯、饮食情况、疾病史、家族史,以及体检、实验室检测等数据,用多因素条件logistic回归分析,探讨痛风发病的危险因素。结果多因素条件logistic回归分析发现,痛风家族史、动物内脏摄入量≥25 g/d、超敏C反应蛋白(hs-CRP)≥2.5 mg/L、同型半胱氨酸(Hcy)≥15μmol/L均可显著增加高尿酸血症者发生痛风的风险,其危险度[OR(95%CI)分别为2.473(1.065-5.744)、2.595(1.025-6.572)、2.535(1.354-4.749)和3.861(1.887-7.901)]。结论痛风家族史、动物内脏摄入量大、hs-CRP升高、Hcy升高是高尿酸血症者发生痛风的危险因素。为预防和减少痛风的发作,建议高尿酸血症者定期检查血液生化指标,减少动物内脏摄入量。
Objective To investigate the risk factors of gout progress in adults with hyperuricemia and provide a scientific evidence for early prevention of gout.Methods A 1:1 matched case-control study was carried out. Data were from the investigation of gout in 2015-2016 in Guangxi. The case group had 129 gout patients and 129 cases of only hyperuricemia as control group, whose sex, ethnic, age( plus or minus 3 years) and residental town was matched with those of the case group. The data including the demographic characters, behavior habits, diet, personal disease history and family history of gout attacks,results of physical examinations and laboratory tests of the blood biochemical indexs were collected. Multivariate conditional logistic regression analyses was applied to explore the risk factors of gout attack. Results The results of multivariate logstic regression analysis showed that family history of gout attacks,animal offal intake ≥25 g/d, hs-CRP≥2.5 mg/L and hyperhomocysteinemia(≥15 μmol/L) increased the risk of gout in patients with hyperuricemia; the OR(95%CI) valuses were 2.473(1.065-5.744), 2.595( 1.025-6.572),2.535( 1.354-4.749) and 3.861( 1.887-7.901), respectively. Conclusions Family history of gout attacks, prefering to take animal offal, elevated hs-CRP and hyperhomocysteinemia are risk factors of gout attacks in patients with hyperuricemia. For preventing and reducing the risks of gout attacks for patients with hyperuricemia one should decrease the intake of animal offal and regually monitor the blood biochemical indexs.
Objective To investigate the risk factors of gout progress in adults with hyperuricemia and provide a scientific evidence for early prevention of gout.Methods A 1:1 matched case-control study was carried out. Data were from the investigation of gout in 2015-2016 in Guangxi. The case group had 129 gout patients and 129 cases of only hyperuricemia as control group, whose sex, ethnic, age( plus or minus 3 years) and residental town was matched with those of the case group. The data including the demographic characters, behavior habits, diet, personal disease history and family history of gout attacks,results of physical examinations and laboratory tests of the blood biochemical indexs were collected. Multivariate conditional logistic regression analyses was applied to explore the risk factors of gout attack. Results The results of multivariate logstic regression analysis showed that family history of gout attacks,animal offal intake ≥25 g/d, hs-CRP≥2.5 mg/L and hyperhomocysteinemia(≥15 μmol/L) increased the risk of gout in patients with hyperuricemia; the OR(95%CI) valuses were 2.473(1.065-5.744), 2.595( 1.025-6.572),2.535( 1.354-4.749) and 3.861( 1.887-7.901), respectively. Conclusions Family history of gout attacks, prefering to take animal offal, elevated hs-CRP and hyperhomocysteinemia are risk factors of gout attacks in patients with hyperuricemia. For preventing and reducing the risks of gout attacks for patients with hyperuricemia one should decrease the intake of animal offal and regually monitor the blood biochemical indexs.
引文
[1]中国医师协会心血管内科医师分会.无症状高尿酸血症合并心血管疾病诊治建议中国专家共识[J].中国临床医生,2011,39(2):73-77.
[2]曾学军.《2010年中国痛风临床诊治指南》解读[J].中国实用内科杂志,2012,32(6):438-441.
[3]Wallace SL,Robinson H,et al.Preliminary criteria for the classification of the acute arthritis of primary gout[J].Arthritis Rheum,1977,20(3):895-900.
[4]Yu S,Guo X,et al.Combination of hyperuricemia and metabolic syndromeis an independent and powerful predictor for left ventricular hypertrophy in rural Chinese[J].Ann Endocrinol(Paris),2015,76(3):264-271.
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[6]藤森新.高尿酸血症[J].日本医学介绍,2001,22(7):307-309.
[7]Roddy E,Doherty M.Epidemiology of gout[J].Arthritis Res Ther,2010,12(6):223.
[8]Lu X,Li X,et al.Contemporary epidemiology of gout and hyperuricemia in community elderly in Beijing[J].Int J Rheum,2014,17(4):400-407.
[9]吴兴华,陈玉柱,周为文,等.广西痛风患者膳食和饮酒危险因素的病例对照研究[J].应用预防医学,2016,22(1):19-25.
[10]Choi HK,Atkinson K,Karlson EW,et al.Purine-rich foods,dairy and protein intake,and the risk of gout in men[J].N Engl J Med,2004,350(11):1093-1103.
[11]王钰.个性化饮食指导对原发性痛风患者的影响[J].齐鲁护理杂志,2010,16(24):101.
[12]中国营养学会.中国居民膳食指南(2016)[M].3版.北京:人民卫生出版社,2016:50-55.
[13]Ikkruthi S,Rajappa M,et al.Hyperhomocysteinemia and hyperlipoproteinemia(a)in obese South Indian men:an indication for increased cardiovascular risk[J].Acta Physiol Hung,2014,101(1):13-20.
[14]Wu Y,Huang Y,Hu Y,et al.Hyperhomocysteinemia is an independent risk factor in young patients with coronary artery disease in Southern China[J].Herz,2013,38(7):779-784.
[15]Slot O.Homocysteine,a marker of cardiovascular disease risk,is markedly elevated in patients with gout[J].Ann Rheum Dis,2013,72(3):457.
[16]Windgassen EB,Funtowicz L,Lansford TN,et al.C-reactive protein and high-sensitivity C-reactive protein:an update for clinicians[J].Postgrad Med,2011,123(1):114-119.
[17]刘国生,周发为,唐生尧,等.超敏C反应蛋白在痛风性关节炎诊疗中的价值[J].湖北民族医学院学报,2014,31(3):22-24.
[18]叶琛.超敏C反应蛋白对急性ST段抬高心急梗死患者心脏终点事件的预测价值[J].临床合理用药杂志,2014,21(36):7-8.
[19]黄志饶,江中芳,王友莲.基线超敏C反应蛋白对高尿酸血症患者发生急性痛风性关节炎的风险预测价值[J].中国药物与临床,2016,16(10):1475-1477.
[20]王新宴,宁波,王文清,等.高尿酸血症和痛风患者血清超敏C反应蛋白水平观察[J].人民军医,2008,51(12):791-792.
[21]高展,丛文东,罗丹.不同剂量叶酸及维生素B12治疗高同型半胱氨酸血症疗效分析[J].河北医药,2012,34(17):2614-2616.
[2]曾学军.《2010年中国痛风临床诊治指南》解读[J].中国实用内科杂志,2012,32(6):438-441.
[3]Wallace SL,Robinson H,et al.Preliminary criteria for the classification of the acute arthritis of primary gout[J].Arthritis Rheum,1977,20(3):895-900.
[4]Yu S,Guo X,et al.Combination of hyperuricemia and metabolic syndromeis an independent and powerful predictor for left ventricular hypertrophy in rural Chinese[J].Ann Endocrinol(Paris),2015,76(3):264-271.
[5]孙长颢,凌文华.营养与食品卫生学[M].7版.北京:人民卫生出版社,2012:201.
[6]藤森新.高尿酸血症[J].日本医学介绍,2001,22(7):307-309.
[7]Roddy E,Doherty M.Epidemiology of gout[J].Arthritis Res Ther,2010,12(6):223.
[8]Lu X,Li X,et al.Contemporary epidemiology of gout and hyperuricemia in community elderly in Beijing[J].Int J Rheum,2014,17(4):400-407.
[9]吴兴华,陈玉柱,周为文,等.广西痛风患者膳食和饮酒危险因素的病例对照研究[J].应用预防医学,2016,22(1):19-25.
[10]Choi HK,Atkinson K,Karlson EW,et al.Purine-rich foods,dairy and protein intake,and the risk of gout in men[J].N Engl J Med,2004,350(11):1093-1103.
[11]王钰.个性化饮食指导对原发性痛风患者的影响[J].齐鲁护理杂志,2010,16(24):101.
[12]中国营养学会.中国居民膳食指南(2016)[M].3版.北京:人民卫生出版社,2016:50-55.
[13]Ikkruthi S,Rajappa M,et al.Hyperhomocysteinemia and hyperlipoproteinemia(a)in obese South Indian men:an indication for increased cardiovascular risk[J].Acta Physiol Hung,2014,101(1):13-20.
[14]Wu Y,Huang Y,Hu Y,et al.Hyperhomocysteinemia is an independent risk factor in young patients with coronary artery disease in Southern China[J].Herz,2013,38(7):779-784.
[15]Slot O.Homocysteine,a marker of cardiovascular disease risk,is markedly elevated in patients with gout[J].Ann Rheum Dis,2013,72(3):457.
[16]Windgassen EB,Funtowicz L,Lansford TN,et al.C-reactive protein and high-sensitivity C-reactive protein:an update for clinicians[J].Postgrad Med,2011,123(1):114-119.
[17]刘国生,周发为,唐生尧,等.超敏C反应蛋白在痛风性关节炎诊疗中的价值[J].湖北民族医学院学报,2014,31(3):22-24.
[18]叶琛.超敏C反应蛋白对急性ST段抬高心急梗死患者心脏终点事件的预测价值[J].临床合理用药杂志,2014,21(36):7-8.
[19]黄志饶,江中芳,王友莲.基线超敏C反应蛋白对高尿酸血症患者发生急性痛风性关节炎的风险预测价值[J].中国药物与临床,2016,16(10):1475-1477.
[20]王新宴,宁波,王文清,等.高尿酸血症和痛风患者血清超敏C反应蛋白水平观察[J].人民军医,2008,51(12):791-792.
[21]高展,丛文东,罗丹.不同剂量叶酸及维生素B12治疗高同型半胱氨酸血症疗效分析[J].河北医药,2012,34(17):2614-2616.