痛风患者伴发疾病与诊治现状调查

目的了解痛风患者伴发疾病情况及目前痛风的诊治现状。方法采用现况调查方法，对2008年4月至10月就诊于北京大学人民医院风湿科门诊的200例痛风患者的一般资料、伴发疾病、诊断及治疗进行现场调查，并记录近3个月的血脂、血肌酐、血尿酸、尿常规结果，用肾脏病膳食改良试验（MDRD）公式计算肾小球滤过率。结果痛风患者伴发高血压、肥胖、肾结石、冠心病、脑梗死、糖尿病的分别为54．5％（109／200）、23．2％（42／181）、20．0％（40／200）、12．0％（24／200）、8．0％（16／200）和7．0％（14／200）。伴发高甘油三酯血症为53．7％（101／188）。63．7％（114／179）的患者有肾功能下降，15．1％（27／179）伴发慢性。肾脏病。200例患者中分别有124例（62％）、72例（36％）、12例（6％）和30例（15％）于痛风急性发作期使用非甾体抗炎药、秋水仙碱、糖皮质激素及降血尿酸药物。痛风间歇期，符合较公认降血尿酸治疗指征的患者中69．8％（81／116）接受过降血尿酸治疗，仅8．6％（10／116）血尿酸水平维持在0．06g／L以下。不符合降血尿酸治疗指征者中73．8％（48／65）也接受了降血尿酸治疗。结论痛风患者最常见的伴发疾病是高血压、高脂血症及肥胖，其次是肾结石、慢性肾脏病和冠心病等。非甾体抗炎药是痛风急性发作期首选治疗，患者降血尿酸治疗时机与目前国际上较公认的指征不一致，达到治疗目标的比例低。

A cross-sectional study on associated diseases in patients with gout and their diagnoses and therapy

Objective To investigate prevalence of associated diseases in patients with gout as well as their diagnoses and treatment. Methods Two hundreds out-patients diagnosed with gout from April to October 2008 were investigated at Peking University People's Hospital, and information collected included their general characteristics, associated diseases, diagnoses and treatment, as well as blood lipid profiles, serum creatinine, uric acid, results of routine urine tests and glomerular filtration rate estimated by MDRD formula in the past three months. Results Among patients with gout, prevalence of associated hypertension, obesity, renal calculi, coronary heart disease, cerebral infarction and diabetes were 54.5% (109/200), 23.2% (42/181), 20.0% (40/200), 12.0% (24/200), 8.0% (16/200) and 7.0% (14/200), respectively, and 53.7% (101/188) of them associated with hypertriglyceridemia, 63.7% (114/179) with impaired renal function and 15.1% (27/179) with chronic kidney disease. In acute attack of gout, 124 (62.0%) of them were treated with non-steroidal anti-inflammatory drug (NASID), 72 (36.0%) with colchicines, 12 (6.0%) with corticosteroid and 30 (15.0%) with urate-lowering drugs, respectively, and during its intermittent period, 69. 8% (81/116) of them received urate-lowering therapy with indications generally accepted internationally, but serum level of uric acid could be maintained below 0.06 g/L in only 8.6% (10/116) of them. And 73.8% (48/65) of the patients with no therapy indications also were treated with urate-lowering drugs. Conclusions The most commonly associated diseases in gout patients are hypertension, hyperlipidemia and obesity, followed by renal calculi, chronic kidney disease and coronary heart disease, and so on. At present, oral NSAID is the first choice of drugs for its acute attack. Indications for urate-lowering therapy in this hospital usually are not consistent with those by generally international acceptance, with lower therapeutic effectiveness achieved.