原发性痛风危险因素的研究

 目的 探讨原发性痛风的危险因素。方法 病例-对照研究1996年1月～2000年1月专科门诊132名新患者,资料处理采用条件Logistic回归分析。结果 原发痛风的独立危险因素：职业、外向性格、饮酒、高嘌呤膳食、高血压及家族史、冠心病及家族史、目前收缩压和舒张压、体质指数(BMI)、尿酸清除分数、急性痛风关节炎发作部位的外伤史、痛风家族史、甘油脂(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL)、极低密度脂蛋白胆固醇(VLDL)的升高及高密度脂蛋白胆固醇2(HDL2C)的降低。结论 国人对于原发痛风的危险因素应早期预防。     

原发痛风的临床特点及高危因素分析

 目的对原发痛风的临床特点及高危因素进行分析.方法病例选自2002年1月～2004年12月在痛风门诊就诊的165例新患者,资料处理采用条件Logistic回归分析.结果发病年龄范围24～72岁,男163例,女2例.首发部位以第1跖趾关节最常见138例(86.3%).原发痛风的独立危险因素:高血压及家族史、冠心病及家族史、目前收缩压和舒张压、BMI、尿酸排泄分数、急性痛风关节炎发作部位的外伤史、痛风家族史、TG、TC、LDL、VLDL的升高及HDL2-C的降低.结论国人对于原发痛风的危险因素应早期预防.     

脑梗死复发的危险因素临床分析

目的探讨脑梗死复发的危险因素,为高危人群的干预治疗提供依据。方法收集复发性脑梗死患者与初发脑梗死患者的临床资料,对两组患者的危险因素(高血压、糖尿病、高脂血症、心脏病、卒中史、近期感染、吸烟史)、辅助检查、预后与转归进行比较。结果两组比较复发组在原发性高血压史、高脂血症、糖尿病史、吸烟、饮酒、近期感染等均较初发组高。空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白复发组也高于初发组。复发组治愈、好转率低,无效及死亡率均高于初发组。结论原发性高血压、高脂血症、糖尿病、吸烟、饮酒、近期感染是脑梗死复发的危险因素。复发性脑梗死治愈、好转率低,无效及死亡率高。     

高血压对男性冠心病患者血脂和载脂蛋白的影响

 目的观察高血压对男性冠心病患者血脂和载脂蛋白的影响.方法将276例患者分为高血压病组(EH,83例)、冠心病组(CHD,85例)、高血压合并冠心病组(EH+CHD,108例).选择健康体检者106例作为对照组.比较三组患者的血脂和载脂蛋白的变化情况,并做分层分析.结果(1)三组患者的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(Apo B)水平均明显高于对照组,而高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A-I(Apo AI)和Apo AI/B的水平明显降低(P＜0.05).(2)未按年龄分组时,各项血脂水平在三组患者中差异无统计学意义.(3)按年龄分层后,≤55岁组中EH+CHD组TC、甘油三酯(TG)和LDL-C的水平最高.结论高血压患者存在血脂代谢紊乱,在合并冠心病时高血压对血脂具有叠加作用,应加强中青年男性高血压患者的调脂治疗.     

军队男性干部冠心病危险因素分析

目的探讨部队男性干部冠心病危险因素分布,比较老年干部与非老年干部冠心病危险因素的差异。方法选择2006-2009年在我院疗养的男性干部2670人,将60～92岁的1869人列为老年组,将35～59岁的801人列为非老年组。结果非老年组饮酒、吸烟、舒张期高血压、低高密度脂蛋白的检出率分别为48.4%、28.2%、32.5%、9.2%明显高于老年组的46.3%、19.9%、12.1%、3.4%(P<0.05),而老年组超重、收缩期高血压、高餐后血糖的检出率分别为50.2%、34.2%、62.1%,高于非老年组的24.1%、9.6%、27.4%(P<0.05)。两组高三酰甘油、高胆固醇的检出率相比无统计学意义(P>0.05)。结论军队非老年干部冠心病危险因素主要为吸烟、饮酒、舒张期高血压、低高密度脂蛋白胆固醇。老年干部冠心病危险因素主要为超重、收缩期高血压、高餐后血糖。     

某高校退休职工骨质疏松现状调查及影响因素分析

 目的 了解某高校退休职工骨质疏松症(osteoporosis,OP)现状,分析骨质疏松相关影响因素。方法 选取2016年1－6月于北京交通大学社区卫生服务中心参加常规体检的785名该校离退休教职工,采用双能X线骨密度仪( DXA)测腰椎(L_1-4)、股骨颈、Ward三角区、大转子区的骨密度,并进行标准的问卷调查及实验室常规检测,根据骨密度分为骨质疏松组和非骨质疏松组,单因素方差分析比较两组一般资料,利用多因素Logistic回归分析骨质疏松的影响因素。结果 OP患病率为23.06%。单因素分析结果显示,两组在性别、年龄、压力、文化程度、吸烟、饮酒、饮牛奶、收缩压、舒张压、体重指数(BMI)、腰臀比(WHR)、三酰甘油(TG)、总胆固醇(TC)、 低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖尿病、冠心病、脑卒中、高血压病史方面均有统计学差异(P<0.05)。多因素Logistic回归分析发现,女性、增龄、大WHR、吸烟、合并高血压、糖尿病、脑卒中、冠心病为OP可能危险因素,高文化程度、高BMI为OP保护因素。结论 退休教职工OP状况严峻,患病率较高,年龄增大、女性、向心性肥胖、吸烟、合并高血压、糖尿病、脑卒中、冠心病的人群更容易发生OP。     

缺血性脑卒中发病因素的病例对照分析

目的探讨缺血性脑卒中的相关危险因素,为采取有效的防治措施提供科学依据。方法选择我院新发的缺血性脑卒中患者120例为病例组,1∶1匹配年龄相差≤3岁、同性别和同民族的非心脑血管病患者120例作为对照组。单因素和多因素条件Logistic回归筛选危险因素。结果 (1)单因素分析显示高血压史、心脏病史、糖尿病史、病前血压波动、高胆固醇血症、高血压家族史、吸烟、饮酒、爱吃咸食、低密度脂蛋白升高、高血尿酸、性格急躁、经常性紧张均为缺血性脑卒中的危险因素,体育锻炼是保护因素。(2)高血压病(OR=3.544,95%;CI:1.923～6.530)、吸烟(OR=3.219,95%;CI:1.760～5.889)、心脏病史(OR=2.409,95%;CI:1.382～4.197)、糖尿病(OR=1.914,95%;CI:1.106～3.311)入选多因素条件Logistic回归方程。结论高血压病史、吸烟、心脏病史、糖尿病是缺血性脑卒中发生的独立危险因素,预防脑卒中的关键在于控制和干预这些危险因素。     

心脑血管病的危险因素与血液流变学参数的关系

目的　探讨高血压、吸烟、饮酒、高脂血症、肥胖等心脑血管病危险因素与血液流变学参数的关系。方法　对 1 5 8名离退休老干部询问病史、体检和检测血脂及血液粘度并进行比较。结果　影响血流变参数的危险因素依次是 :长期大量吸烟 ,高甘油三脂 ,大量饮酒 ,高血压 ,过度肥胖 ,高胆固醇。结论　具有心脑血管病危险因素者血液流变学参数与正常人相比明显异常。     

民航飞行人员心血管疾病危险因素的现状分析

为了解民航飞行人员心血管疾病危险因素的现状,深入研究及制定合理的预防措施是提供依据。我们采用整群抽样的方法,对西安、兰州两地共４４３名飞行人员心血管疾病的危险因素,主要包括高血压、高血脂、体重超重、吸烟、口味偏咸及心血管疾病家族史进行调查。结果发现,心血管疾病危险因素在民族飞行人员中暴露水平较高,高血压、高血脂、体重超重、吸烟、饮烟、饮酒、口味偏咸及心血管家族史的暴露率分别为６．８％、３８．４％、３４．１％、４４．９％、１５．８％、３８．１％有１２．８％。其中高血压、高血脂、体重超重、吸烟及饮酒在４０岁以上年龄组飞行人员中的暴露率显高于４０岁以下年龄组飞行人员（Ｐ〈０．０１）,飞行时间超过１００００小时的飞行人员,其高血压、高血脂、体重超重、吸烟及饮酒珠暴露率较飞行时间不到１００００小时的飞行人员亦显增加（     

铁路职工高同型半胱氨酸血症发生情况及危险因素探讨

 目的 探讨高同型半胱氨酸血症的发生情况及其相关的危险因素。方法 选取2017-03至2018-12在中心进行体检的铁路职工76 456人。依据血清同型半胱氨酸(HCY)检测结果按照排除标准与入选标准共纳入研究对象68 383人。收集包括既往史、家族史及烟酒嗜好等病史资料。测量研究对象的身高、体重、收缩压(SBP)、舒张压(DBP)并计算体质指数(BMI)。进行空腹血糖(FBG)、胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、HCY、尿酸(UA)等指标的检测。分析比较不同水平HCY上述指标的差异以及不同危险因素下HCY的差异,采用逐步回归法进行HCY与影响因素的多重线性回归分析,得出相关性。结果 HCY正常组42 929人,HCY增高组25 454人。两组间年龄、男性比例、心脑血管病既往史、高血压既往史、吸烟率、饮酒率、BMI、SBP、DBP、TG、LDL-C、UA等比较均有统计学意义(P＜0.05),HCY增高组HDL-C(1.168±0.296)低于正常组(1.198±0.295),差异有统计学意义(P＜0.05)。超重组及肥胖组血HCY水平均高于体重正常组,三组间两两比较差异均有统计学意义(P＜0.05);一级高血压组、二级高血压组及三级高血压组血HCY水平均高于血压正常组,差异有统计学意义(P＜0.001)。多重线性回归分析结果显示:性别、吸烟、UA升高、三级高血压、年龄(53～60岁)、二级高血压、饮酒、高血压既往史、TG升高、HDL-C降低与HCY升高存在线性关系(F=706 059.453,P＜0.001)。结论 性别、吸烟、血尿酸、高血压、年龄、饮酒、TG、LDL-C是高同型半胱氨酸血症的影响因素。     

Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray

The aim was to compare X-ray and ultrasound (US) in diagnosing gout. In a prospective study, 105 consecutive patients with clinical suspicion of gout underwent conventional X-ray und high-resolution US in order to help in arriving at a definite diagnosis. X-ray findings suggestive of gout included soft-tissue opacifications with densities between soft tissue and bone, articular and periarticular bone erosions, and osteophytes at the margins of opacifications or erosions. US findings suggestive of gout included bright stippled foci and hyperechoic soft-tissue areas. Fifty-five patients had a definite diagnosis of gout (102 involved sites), 31 patients were diagnosed as having another disease (59 involved sites), and 19 patients were excluded from the study because a definite diagnosis could not be established. X-ray suggested gout with a sensitivity of 31% (32/102) and a specificity of 93% (55/59), whereas US suggested gout with a sensitivity of 96% (98/102) and a specificity of 73% (43/59). US was much more sensitive than conventional X-ray but less specific. Our data show that US often provided additional diagnostic information in patients with clinical suspicion of gout when laboratory findings and X-ray results were negative or inconclusive and should therefore be used in these cases.     

2011 recommendations for the diagnosis and management of gout and hyperuricemia

Gout is a major health problem in the United States; it affects 8.3 million people, which is approximately 4% of the adult population. Gout is most often diagnosed and managed in primary care practices; thus, primary care physicians have a significant opportunity to improve patient outcomes. Following publication of the 2006 European League Against Rheumatism (EULAR) gout guidelines, significant new evidence has accumulated, and new treatments for patients with gout have become available. It is the objective of these 2011 recommendations to update the 2006 EULAR guidelines, paying special attention to the needs of primary care physicians. The revised 2011 recommendations are based on the Grading of Recommendations Assessment, Development, and Evaluation approach as an evidence-based strategy for rating quality of evidence and grading the strength of recommendation formulated for use in clinical practice. A total of 26 key recommendations, 10 for diagnosis and 16 for management, of patients with gout were evaluated, resulting in important updates for patient care. The presence of monosodium urate crystals and/or tophus and response to colchicine have the highest clinical diagnostic value. The key aspect of effective management of an acute gout attack is initiation of treatment within hours of symptom onset. Low-dose colchicine is better tolerated and is as effective as a high dose. When urate-lowering therapy (ULT) is indicated, the xanthine oxidase inhibitors allopurinol and febuxostat are the options of choice. Febuxostat can be prescribed at unchanged doses for patients with mild-to-moderate renal or hepatic impairment. The target of ULT should be a serum uric acid level that is ≤ 6 mg/dL. For patients with refractory and tophaceous gout, intravenous pegloticase is a new treatment option. This article is a summary of the 2011 clinical guidelines published in Postgraduate Medicine. This article provides a streamlined, accessible overview intended for quick review by primary care physicians, with the full guidelines being a resource for those seeking additional background information and expanded discussion.     

美宝创疡贴治疗1例痛风并发难治性溃疡的临床体会

为了进一步观察美宝创疡贴治疗痛风并发难治性溃疡的临床疗效,我们对2010年11月收治的1例痛风并发溃疡创面采用美宝创疡贴处理.该病例为53岁男性患者,痛风病史16年,近5年来双侧内踝处皮肤反复出现溃疡,曾在外院接受8次植皮手术治疗,效果都不理想.末次手术后溃疡再次复发,在积极治疗原发病的同时,对溃疡创面予以美宝创疡贴外敷处理,原发病得到有效控制,溃疡愈合,未见复发.     

Impact of sonography in gouty arthritis: comparison with conventional radiography, clinical examination, and laboratory findings

OBJECTIVE: To explore the typical sonographic features of gray-scale and Power Doppler of acute and chronic gouty arthritis in conjunction with radiographic, clinical, and laboratory findings. MATERIALS AND METHODS: All hand, finger, and toe joints of 19 patients with acute and chronic gout were examined with gray-scale and Power Doppler sonography. The number and size of bone changes detected with sonography was compared to radiographic findings. Vascularization of the synovial tissue was scored on Power Doppler (grades 0-3), and was compared with clinical appearance, including swelling, tenderness, and redness (grades 0-3). RESULTS: In acute gout, mild to moderate echogenic periarticular nodules with sonotransmission and hypervascularization of the edematous surrounding soft tissue were found. In chronic gout, tophaceous nodules completely blocked transmission of US wave, leading to strong reflexion and dorsal shadowing in a minority of cases. No significant difference in the detection of large bone changes (>2mm) was found between sonography and radiography. However, gray-scale sonography was significantly more sensitive in the detection of small bone changes (p<0.001). Power Doppler scores were statistically significantly higher than clinical examination scores (p<0.001). DISCUSSION: Sonography is superior to radiographs in evaluating small bone changes. The inflammatory process in joints can be better detected with Power Doppler sonography than with clinical examination. Typical sonographic appearance of acute and in particular of chronic gout might provide clues on gouty arthritis that adds to the information available from conventional radiography, clinical, and laboratory findings.     

原发痛风对血脂、纤溶活性和凝血的影响

 目的 探讨原发痛风对血脂、凝血和纤溶活性的影响。方法1996年1月～2000年12月原发痛风患者133人,与健康者(正常对照)135人做病例对照研究,比较血脂、凝血和纤溶活性指标的变化,血脂引入条件Logistic回归分析。结果病例与对照两组均数比较,TG、LDL、VLDL、apo-B、Lp(a)病例组明显高于对照(P＜0.01);HDL-C、HDL2-C病例组低于对照组。病例与对照两组均数比较,结果显示：TG、LDL、VLDL、apo-B、Lp(a)病例组明显高于对照(P＜0.01);HDL-C、LDL 2-C病例组低于对照组,TG、TC、LDL、VLDL的升高及HDL 3-C的降低与痛风危险存在统计学相关。tPA明显低于对照;PAI病例组明显高于对照组。结论 原发痛风患者早期需防治动脉粥样硬化。     

痛风性关节炎与单纯性高尿酸血症临床指标的比较

 目的 探讨痛风性关节炎(gout arthritis,GA)与单纯性高尿酸血症(simple hyperuricemia,SHUA)在临床指标上的差异性。方法 选择2011-01至2017-08武警湖北总队医院住院的151例高尿酸血症(hyperuricemia,HUA)患者的临床资料进行了回顾性分析,以存在GA症状的43例为GA组,其他为SHUA的108例为SHUA组;比较GA组和SHUA组在年龄、性别、体重指数(BMI)、吸烟饮酒史、血压、血压异常率、空腹血糖(FPG)、血糖异常率、三酰甘油(TG)、胆固醇(CHOL)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、血肌酐(CR)、血尿酸(UA)、心脏左室缩短分数(Left ventricular shortening fraction,LVFS)、左室心脏射血分数(Left ventricular ejection fraction,LVEF)指标上的差异情况。结果 (1)两组在年龄、吸烟史、饮酒史、BMI方面比较,差异无统计学意义,但GA组中男性患者比例较SHUA组更高(P=0.01)。(2)与SHUA组相比较,GA组的血糖异常率、FPG水平、血压异常率、收缩压水平、TG水平更低,差异有统计学意义(P<0.05)。(3)GA组CR水平明显高于SHUA组,差异有统计学意义(P=0.001)。(4)两组UA水平无统计学差异。(5)GA组LVFS明显高于SHUA组,差异有统计学意义(P=0.024)),但两组LVEF比较无统计学差异。结论 在所有的HUA中,GA患者的临床指标较SHUA患者更优。     

双能CT Volume软件定量分析尿酸盐结晶的临床应用

目的 利用双能CT(DECT)中Volume软件对双能量成像尿酸盐结晶的体积进行定量分析,评价其临床应用价值.方法 回顾性分析60例符合美国风湿病协会(ACR)诊断标准的痛风患者的DECT扫描结果,由2位高年资放射科医师利用Volume软件分别对尿酸盐结晶的体积进行定量分析,并对结果进行统计学分析.结果 60例患者共扫描了72对关节,其中43对足踝关节,出现尿酸盐结晶40对,平均体积(0.621±0.742)cm3;19对膝关节,出现尿酸盐结晶18对,平均体积(0.842±1.086)cm3;10对手腕关节,出现尿酸盐结晶10对,平均体积(0.796±0.583)cm3.2位医师对尿酸盐结晶体积的统计无统计学差异(P>0.05).有4例患者规律服药后复查CT显示尿酸盐结晶体积均有减少.结论 DECT的Volume软件可对尿酸盐结晶进行定量分析,可重复性较强,对临床诊断痛风及疗效监测具有较高的应用价值.     

The distribution of urate deposition within the extremities in gout: a review of 148 dual-energy CT cases

Objective

Clinical detection of gout can be difficult due to co-existent and mimicking arthropathies and asymptomatic disease. Understanding of the distribution of urate within the body can aid clinical diagnosis and further understanding of the resulting pathology. Our aim was to determine this distribution of urate within the extremities in patients with gout.

Materials and methods

All patients who underwent a four-limb dual-energy computed tomography (DECT) scan for suspected gout over a 2-year period were identified (n?=?148, 121 male, 27 female, age range, 16–92 years, mean?=?61.3 years, median?=?63 years). The reports of the positive cases were retrospectively analyzed and the locations of all urate deposition recorded and classified by anatomical location.

Results

A total of 241 cases met the inclusion criteria, of which 148 cases were positive. Of these, 101 (68.2 %) patients had gout in the foot, 81 (56.1 %) in the knee, 79 (53.4 %) in the ankle, 41 (27.7 %) in the elbow, 25 (16.9 %) in the hand, and 25 (16.9 %) in the wrist. The distribution was further subcategorized for each body part into specific bone and soft tissue structures.

Conclusions

In this observational study, we provide for the first time a detailed analysis of extremity urate distribution in gout, which both supports and augments to the current understanding based on clinical and microscopic findings.