痛风患者骨侵蚀检出现状及相关因素分析

目的 了解痛风患者发生骨侵蚀现状，并分析其发生相关的影响因素，为痛风患者骨侵蚀的预防与诊疗提供支持。方法 选取2020年4月至2021年2月于四川省成都市某风湿专科医院确诊的痛风患者513例，调查并测量其基本特征、健康状况、行为生活方式与临床指标，通过影像学检查判断患者是否发生骨侵蚀。采用多因素logistic回归模型分析骨侵蚀发生的相关因素，检验水准α=0.05。结果 513例痛风患者中241例发生骨侵蚀，检出率为46.98%。年龄、文化程度、婚姻状况、痛风病程、过去一年的痛风发作次数、高血压、血尿酸（SUA）、血尿素氮（BUN）、血肌酐（SCr）、胱抑素C（Cys-C）、甘油三酯（TG）、总蛋白（STP）、坚果类摄入、豆类及其制品摄入以及牛羊肉摄入在发生骨侵蚀与未发生骨侵蚀的痛风患者间存在差异（均P＜0.05）。多因素分析结果显示，病程（与≤1年相比，6~10年:OR=10.753，95%CI:2.687~43.030；≥11年:OR=31.114，95%CI:7.907~122.438）、过去一年痛风发作次数（与≤3次相比，≥7次:OR=2.347，95%CI:1.201~4.587）、SUA（与＜237.9μmol/L相比，475.8~594.7μmol/L:OR=13.934，95%CI:1.278~151.971；≥594.8μmol/L:OR=24.010，95%CI:2.130~270.615）、BUN（与3.2~7.1mmol/L相比，＞7.1mmol/L:OR=2.243，95%CI:1.178~4.271）、豆类及其制品摄入（与≤1次/周相比，≥3次/周:OR=5.955，95%CI:2.369~14.974）可能是痛风患者发生骨侵蚀的危险因素；文化程度（与小学及以下相比，本科及以上:OR=0.225，95%CI:0.090~0.564）可能是痛风患者发生骨侵蚀的保护因素。结论 痛风患者的骨侵蚀检出率较高。病程、近一年痛风发作次数、SUA、BUN以及豆类及其制品摄入可能是发生骨侵蚀的危险因素，提示临床医生应针对以上因素采取早期干预措施，减少痛风患者骨侵蚀的发生，改善痛风患者的预后。

Current status and related factors associated with bone erosion in gout patients

Objective To determine the occurrence of bone erosion in gout patients and to analyze the factors that influence its occurrence. Methods From April 2020 to February 2021, 513 patients who attended a rheumatology hospital in Chengdu, Sichuan Province and were diagnosed with gout were selected. The basic characteristics, health status and behavioral lifestyles were investigated and the clinical indicators were measured. Imaging was used to check patients for bone erosion. A multi-factor logistic regression model was used to analyze the factors associated with the occurrence of bone erosion, with a test level of α=0.05. Results Bone erosion occurred in 241 of 513 gout patients, with an incidence of 46.98%. Age, education level, marital status, duration of disease, number of episodes in the past year, hypertension, SUA, BUN, SCr, Cys-C, TG, STP, nut intake, pulses and their products intake, and beef and lamb intake differed between patients with and without bone erosion in gout (all P<0.05). Duration of disease (compared to ≤1 year, 6-10 years: OR=10.753, 95%CI: 2.687-43.030; ≥11 years OR=31.114, 95%CI: 7.907-122.438), number of gout attacks in the past year (compared to ≤3, ≥7: OR=2.347, 95%CI: 1.201-4.587), SUA (compared to <237.9μmol/L, 475.8-594.7μmol/L OR=13.934, 95%CI: 1.278-151.971; ≥594.8μmol/L OR=24.010, 95%CI: 2.130-270.615), BUN (compared to 3.2-7.1 mmol/L, >7.1mmol/L OR=2.243, 95%CI: 1.178-4.271) and intake of legumes and their products (compared to ≤1 time/week, ≥3 times/week OR=5.955, 95%CI: 2.369-14.974) were risk factors for bone erosion in gout patients. Literacy (compared to primary school and below, bachelor’s degree and above OR=0.225, 95%CI: 0.090-0.564) was a protective factor against bone erosion in gout patients. Conclusion Patients with gout have a high incidence of bone erosion. The duration of the disease, the number of gout attacks in the last year, SUA levels and the intake of legumes and their products are factors associated with the occurrence of bone erosion. Early preventive measures should be taken to address these factors to reduce the occurrence of bone erosion in gout patients and improve their prognosis.