Sheng Feng, Fang Weigang, Zhang Bingqing, Sha Yue, Zeng Xuejun
Division of General Internal Medicine, Peking Union Medical College Hospital, Beijing, China.
Medicine (Baltimore). 2017 Nov;96(45):e8532. doi: 10.1097/MD.0000000000008532.
Though efficacious and affordable treatments for gout are widely available, gout is still not well controlled in many countries of the world including China.To investigate patient adherence to gout management recommendations and potential barriers in Chinese male gout patients, a survey was carried out by telephone interview in male patients registered in the gout clinic at Peking Union Medical College Hospital. Adherence to dietary and medication recommendations was measured by a food frequency questionnaire and proportion of cumulative time adherent to chemical urate-lowering therapy (ULT), respectively. Dietary adherence was defined as consumption of alcohol, seafood and animal organs less than once per month, and reduced red meat after dietary counseling. Medication adherence was defined as ULT ≥80% of time in the past 12 months for patients with indications. Logistic regression models were used to identify patient characteristics associated with management adherence. Reasons for nonadherence were also sought by open-end questions.Dietary and medication adherence were 44.2% and 21.9%, respectively. Older age (odds ratio [OR] 7.90, 95% confidence interval [CI] 2.49-25.04 for age ≥60), higher serum uric acid (sUA) levels (OR 3.53, 95% CI 1.42-8.75 for the highest quartile), and tophi (OR 2.31, 95% CI 1.12-4.77) were associated with dietary adherence independently, while tophi (OR 14.05, 95% CI 2.67-74.08) and chronic kidney disease (OR 16.66, 95% CI 2.63-105.37) were associated with medication adherence independently. Reasons that patients reported for nonadherence to medication included remission after treatment (35.3%), concerns for potential side effects (22.7%), insufficient patient education (8.7%), and adverse events (8.2%).Patient adherence to gout management recommendations is poor in China. Older age, increased disease burden, and specific comorbidities were associated with management adherence.
尽管痛风的有效且经济实惠的治疗方法广泛可得，但在包括中国在内的世界许多国家，痛风仍未得到很好的控制。为了调查中国男性痛风患者对痛风管理建议的依从性以及潜在障碍，在北京协和医院痛风门诊登记的男性患者中通过电话访谈进行了一项调查。分别通过食物频率问卷和化学降尿酸治疗（ULT）累计依从时间比例来衡量对饮食和药物建议的依从性。饮食依从性定义为每月饮酒、食用海鲜和动物内脏少于一次，并且在饮食咨询后减少红肉摄入。药物依从性定义为有适应症的患者在过去12个月中ULT时间≥80%。使用逻辑回归模型来确定与管理依从性相关的患者特征。还通过开放式问题寻找不依从的原因。饮食和药物依从性分别为44.2%和21.9%。年龄较大（年龄≥60岁时，比值比[OR]为7.90，95%置信区间[CI]为2.49 - 25.04）、血清尿酸（sUA）水平较高（最高四分位数时，OR为3.53，95%CI为1.42 - 8.75）以及痛风石（OR为2.31，95%CI为1.12 - 4.77）分别独立与饮食依从性相关，而痛风石（OR为14.05，95%CI为2.67 - 74.08）和慢性肾脏病（OR为16.66，95%CI为2.63 - 105.37）分别独立与药物依从性相关。患者报告的不依从药物的原因包括治疗后缓解（35.3%）、对潜在副作用的担忧（22.7%）、患者教育不足（8.7%）以及不良事件（8.2%）。中国患者对痛风管理建议的依从性较差。年龄较大、疾病负担增加和特定合并症与管理依从性相关。
