原发性痛风患者326例血尿酸、胱抑素C和脂代谢特点分析及其临床意义

目的 了解原发性痛风患者血尿酸（sUA）、血脂及血浆胱抑素C（CysC）的代谢特点,探讨痛风患者易并发心脑血管疾病的可能机制.方法 检测326例原发性痛风性关节炎（GA）患者和210例健康体检者sUA、CysC、胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、极低密度脂蛋白（VLDL）、载脂蛋白A1（apoA1）、载脂蛋白B100 （apoB100）、超敏C反应蛋白（hsCRP）浓度并完善血细胞计数,详细收集痛风患者临床资料;比较两组上述指标的差异并分析sUA、CysC与各指标的相关性.结果 痛风组sUA、CysC、hsCRP、WBC、中性粒细胞（GR）、体重指数、TG、TC、VLDL、apoB100、血糖、肌酐和尿素均显著高于正常对照组（P均＜0.01）,而淋巴细胞、HDL则显著低于对照组（P均＜0.01）.痛风组sUA与年龄、WBC、TG、VLDL、肌酐及CysC呈显著正相关（r=0.24、0.27、0.27、0.33、0.25、0.21,P均＜0.05）,与HDL-C呈显著负相关（r=-0.16,P＜0.01）;痛风组CysC与WBC、GR、单核细胞计数、apoA1、血糖、肌酐、尿素、hsCRP呈显著正相关（r=0.26、0.20、0.31、0.22、0.46、0.67、0.63、0.33,P均＜0.05）,与TC、LDL-C呈显著负相关（r=-0.25、-0.27,P均＜0.01）.结论 痛风患者血脂异常特点符合致动脉粥样硬化血脂谱的典型特征.痛风患者易出现脂代谢紊乱、易合并心脑血管疾病,可能与高尿酸血症致血管内皮损伤、平滑肌细胞增殖等血管长期慢性炎症反应有关.CysC可能可作为痛风早期肾功能损害及慢性炎症的判定指标.

Altered serum uric acid,Cystatin C and lipids concentration and its clinical significance in 326 primary gouty arthritis patients

Objective To investigate the changes of serum uric acid （sUA）,lipids and cystatin C （CysC）of primary gouty arthritis （GA） patients,and explore the pathogenesis of GA complicating vascular diseases.Methods sUA,CysC,hsCRP,plasma total cholesterol （TC）,triglycerides （TG）,high density lipoproteincholesterol （HDL-C）,low density lipoprotein-cholesterol （LDL-C）,very low density lipoprotein （VLDL）,apolipoprotein A1 （apoA1） and apolipoprotein B100 （apoB100） were measured in 326 GA cases and 210 healthy control subjects,blood cell counts were also detected.Clinical data were collected from GA patients.Results sUA,CysC,hsCRP,Body mass index,white blood cell （WBC） counts,neutrophil granulocyte （GR）,TG,TC,VLDL,apoB100,blood glucose （GLU）,serum creatinine and urea nitrogen were significantly increased in GA patients compared with healthy control subjects （P ＜ 0.01,respectively）,while lymphocyte counts and HDL-C were significantly decreased in GA patients compared with healthy control subjects （P ＜ 0.01,respectively）.Significant positive correlations between concentration of sUA and age,WBC,TG,VLDL,creatinine,CysC （r =0.24,0.27,0.27,0.33,0.25,0.21,P ＜ 0.05,respectively）,between CysC and WBC,GR,monocyte,apoA1,GLU,creatinine,urea nitrogen,hsCRP （r =0.26,0.20,0.31,0.22,0.46,0.67,0.63,0.33,P ＜ 0.05,respectively） were observed in GA patients,while significant negative correlations between concentration of sUA and HDL-C （r =-0.16,P ＜0.01）,between CysC and TC,LDL-C （r =-0.25,-0.27,P ＜ 0.01,respectively） were observed.Conclusions Plasma atherogenic lipid profile is changed in GA patients.Hyperuricemia leads to chronic inflammation of vessel due to endothelial cell damage and vascular smooth muscle cell proliferation,so GA can complicating with disorder of lipid metabolism and vascular diseases.CysC might be as a marker of the renal function damage and inflammation.