Rheumatology Division, Hospital Universitario Cruces, , Baracaldo, Vizcaya, Spain.
Ann Rheum Dis. 2014 Jan;73(1):177-82. doi: 10.1136/annrheumdis-2012-202421. Epub 2013 Jan 12.
While several studies have reported a link between the presence of gout and adverse cardiovascular (CV) events in the general population, none has addressed the question of whether the mortality risk of patients with gout is influenced by disease severity.
We applied survival analysis methodology to prospectively collected data on clinical and radiographic measures of disease severity and mortality in a specialty clinic based cohort of 706 patients with gout (1992-2008). Standardised mortality ratios (SMR) were calculated to assess the magnitude of excess mortality among patients with gout compared with the underlying general population.
Mean follow-up was 47 months. Tophaceous deposition was present in 30.5% of patients; >4 joints were involved in 34.6% of cases. Mean annual flare rate was 3.4. Arterial hypertension (41.2%), hyperlipidaemia (42.2%), diabetes mellitus (20.1%), renal function impairment (26.6%) and a previous CV event (25.3%) were recorded. 64 (9.1%) patients died, death being attributed to vascular causes in 38 (59%) patients. SMR for gout patients was 2.37 (95% CI 1.82 to 3.03), 1.57 (1.18 to 2.05) and 4.50 (2.06 to 8.54) overall, and in men and women, respectively. The presence of tophi and the highest baseline serum urate (SU) levels were independently associated with a higher risk of mortality, in addition to age, loop diuretic use and a history of a previous vascular event. In the multivariable survival regression models, with time varying covariates, the presence of tophi remained a significant mortality risk after adjustment for baseline SU levels (1.98; 1.24 to 3.20).
High baseline SU level and the presence of subcutaneous tophi were both associated with an increased risk of mortality in patients with gout, in most cases attributed to a CV cause. This suggests a plausible pathophysiological link between greater total body urate load and CV disease.
虽然有几项研究报告了痛风患者与不良心血管（CV）事件之间存在关联，但没有一项研究探讨痛风患者的死亡率是否受疾病严重程度的影响。
我们应用生存分析方法，对基于专科诊所的 706 例痛风患者（1992-2008 年）的临床和影像学疾病严重程度和死亡率的前瞻性数据进行分析。通过计算标准化死亡率比（SMR），评估痛风患者的死亡率与基础人群相比是否过高。
平均随访时间为 47 个月。30.5%的患者存在痛风石沉积；34.6%的病例累及>4 个关节。平均每年痛风发作次数为 3.4 次。记录到的合并症包括：高血压（41.2%）、高脂血症（42.2%）、糖尿病（20.1%）、肾功能损害（26.6%）和既往心血管事件（25.3%）。64 例（9.1%）患者死亡，38 例（59%）死亡归因于血管原因。痛风患者的 SMR 为 2.37（95%CI 1.82 至 3.03）、1.57（1.18 至 2.05）和 4.50（2.06 至 8.54），分别为总体、男性和女性。除年龄、使用袢利尿剂和既往血管事件史外，存在痛风石和基线血尿酸（SU）水平最高与死亡率增加独立相关。在多变量生存回归模型中，随着时间变化的协变量，在调整基线 SU 水平后，存在痛风石仍然是死亡的显著危险因素（1.98；1.24 至 3.20）。
高基线 SU 水平和皮下痛风石的存在均与痛风患者的死亡风险增加相关，在大多数情况下归因于心血管原因。这表明体内尿酸总量增加与心血管疾病之间存在合理的病理生理联系。
