痛风患者痛风石形成现状及相关因素分析

目的 了解痛风患者痛风石检出现状,并探讨其形成的相关因素,为痛风患者个性化综合诊疗提供参考。 方法 收集四川省成都市某风湿专科医院2020年4月至2021年2月间的原发性痛风患者508例,调查其饮食行为情况和测量临床指标。痛风石形成相关因素分析采用logistic回归模型,检验水准α=0.05。 结果 508例痛风患者中合并皮下痛风石267例(52.56%),其中男性264例(98.88%),女性3例(1.12%)。单因素分析结果显示,年龄、婚姻状况、痛风病程、高血压、血尿酸、肾小球滤过率、非结合胆红素、总蛋白、血尿素氮、豆类及其制品摄入、坚果类摄入、动物内脏类食物摄入与痛风石形成有关(均P＜0.05)。多因素分析结果显示,乳类及其制品摄入(与＜1次/周相比,≥4次/周:OR=0.253,95%CI:0.065～0.986)、蛋类摄入(与≤2次/周相比,3～5次/周:OR=0.522,95%CI:0.313～0.871)为痛风石形成的保护因素; 痛风病程(与＜1年相比,5～9年:OR=11.106,95%CI:2.263～54.492; ≥10年:OR=40.476,95%CI:8.197～199.876)、血尿酸水平(与＜40.0 mg/L相比,≥100.0 mg/L:OR=5.512,95%CI:1.283～23.674)、豆类及其制品摄入(与≤1次/周相比,≥3次/周:OR=3.078,95%CI:1.260～7.522)、动物内脏类摄入(与＜1次/月相比, 1～3次/月:OR=2.301,95%CI:1.155～4.585; >6次/月:OR=3.364,95%CI:1.239～9.134)为痛风石形成的危险因素。 结论 痛风病程较长且血尿酸水平较高的痛风患者,豆类及其制品、动物内脏类食物摄入频率较高者易形成皮下痛风石。建议痛风患者尽早接受治疗,控制血尿酸水平; 减少动物内脏类、豆类食品摄入,适当增加蛋类、乳类及其制品摄入; 临床医师对痛风患者诊疗时关注其饮食行为情况,帮助患者预防或延缓痛风石形成。

Current status and influencing factors for primary gout patients with subcutaneous tophi

Objective To analyze the current status and risk factors associated with the formation of subcutaneous tophi among primary gout patients. Methods The 508 gout patients at the Rheumatology Hospital in Chengdu from April 2020 to February 2021 were interviewed. The clinical information and dietary situations were collected and relevant biochemical indices were detected. The factors associated with tophi were analyzed by logistic regression, with test level α=0.05. Results There were 267 patients combined with tophi(52.56%)among 508 patients, of which 264 were male(98.88%)and 3 were female(1.12%). Univariate analysis showed that age, marital status, gout course, hypertension, serum uric acid, glomerular filtration rate, unconjugated bilirubin, serum total protein, blood urea nitrogen, legumes and their products intake, nuts intake, animal viscera foods intake in the tophi group were statistically significantly higher than in the group without tophi(all P＜0.05). The multivariable logistic regression analysis further showed that dairy and their products intake(＜1 time weekly vs. ≥4 times weekly: OR=0.253, 95%CI: 0.065-0.986)and eggs intake(≤2 times weekly vs. 3-5 times weekly: OR=0.522, 95%CI: 0.313-0.871)remained protective factors for the formation of tophi, while gout course(＜1 year vs. 5-9 years: OR=11.106, 95%CI: 2.263-54.492; ≥10 years: OR=40.476, 95%CI: 8.197-199.876), serum uric acid(＜40.0 mg/L vs. ≥100.0 mg/L: OR=5.512, 95%CI: 1.283-23.674), legumes and their products intake(≤1 time weekly vs. ≥3 times weekly: OR=3.078, 95%CI: 1.260-7.522), animal viscera foods intake(＜1 time monthly vs. 1-3 times monthly: OR=2.301, 95%CI: 1.155-4.585; >6 times monthly: OR=3.364, 95%CI: 1.239-9.134)remained risk factors for the formation of tophi in the patients. Conclusion Gout patients with advanced course of gout and higher levels of serum uric acid, higher frequency of legumes and their products intake and animal viscera foods intake are prone to complicate with gouty tophi. The patients are advised to place emphasis on initial treatment and control the intake of animal offal and legumes and moderately increase eggs, dairy and their products intake. The clinicians should pay attention to the dietary behaviors of gout patients to help them prevent or delay the formation of subcutaneous tophi.