China Medical University, Taichung, Taiwan.
Arthritis Care Res (Hoboken). 2013 Jan;65(1):133-40. doi: 10.1002/acr.21824.
Hyperuricemia is the most important risk factor for the development of gout; however, not all patients with hyperuricemia develop gout, and patients experiencing a gout attack are not necessarily found to have hyperuricemia. We hypothesized that the interactions between serum uric acid (sUA) and other potential metabolic comorbidities increase the risk of gout development.
A prospective study was conducted to link baseline metabolic profiles from the MJ Health Screening Center to gout outcomes extracted from the Taiwan National Health Insurance database. A Cox proportional hazards model was used to assess the metabolic risks for incident gout stratified by hyperuricemia status (sUA level >7 mg/dl or not).
During a mean followup period of 6.45 years (261,500 person-years), 1,189 patients with clinical gout (899 men, 202 women ages >50 years, and 88 women ages ≤50 years) were identified among the 40,513 examinees. The multivariate adjusted hazard ratios (HRs) of hyperuricemia for gouty arthritis were 5.80 (95% confidence interval [95% CI] 4.93-6.81) in men and 4.37 (95% CI 3.38-5.66) in women. Hypertriglyceridemia (triglyceride level >150 mg/dl) was found as an independent risk factor, with HRs of 1.38 (95% CI 1.18-1.60) in men with hyperuricemia and 1.40 (95% CI 1.02-1.92) in men without hyperuricemia. General obesity (body mass index >27 kg/m(2) ) was independently associated with gout in older women, with HRs of 1.72 (95% CI 1.15-2.56) in women with hyperuricemia and 2.19 (95% CI 1.47-3.26) in women without hyperuricemia.
General obesity in women and hypertriglyceridemia in men may potentiate an sUA effect for gout development. Further investigation is needed.
高尿酸血症是痛风发展的最重要危险因素；然而，并非所有高尿酸血症患者都会发展为痛风，且经历痛风发作的患者不一定存在高尿酸血症。我们推测，血尿酸（sUA）与其他潜在代谢合并症之间的相互作用增加了痛风发病的风险。
进行了一项前瞻性研究，将来自 MJ 健康筛查中心的基线代谢特征与从台湾全民健康保险数据库中提取的痛风结局相关联。采用 Cox 比例风险模型评估按高尿酸血症状态（sUA 水平>7mg/dl 或不）分层的代谢风险。
在平均 6.45 年（261500 人年）的随访期间，在 40513 名受检者中，共确定了 1189 例临床痛风患者（899 名男性，202 名年龄>50 岁的女性和 88 名年龄≤50 岁的女性）。男性高尿酸血症患者痛风性关节炎的多变量调整后的风险比（HR）为 5.80（95%置信区间[95%CI]为 4.93-6.81），女性为 4.37（95%CI 为 3.38-5.66）。高甘油三酯血症（甘油三酯水平>150mg/dl）被认为是一个独立的危险因素，高尿酸血症男性的 HR 为 1.38（95%CI 为 1.18-1.60），无高尿酸血症男性的 HR 为 1.40（95%CI 为 1.02-1.92）。一般肥胖（体重指数>27kg/m2）与老年女性的痛风独立相关，高尿酸血症女性的 HR 为 1.72（95%CI 为 1.15-2.56），无高尿酸血症女性的 HR 为 2.19（95%CI 为 1.47-3.26）。
女性的一般肥胖和男性的高甘油三酯血症可能会增强 sUA 对痛风发病的影响。需要进一步的研究。
