Li Q H, Liang J J, Chen L X, Mo Y Q, Wei X N, Zheng D H, Dai L
Department of Rheumatology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China.
Zhonghua Nei Ke Za Zhi. 2018 Mar 1;57(3):185-190. doi: 10.3760/cma.j.issn.0578-1426.2018.03.007.
To investigate clinical characteristics and renal uric acid excretion in early-onset gout patients. Consecutive inpatients with primary gout were recruited between 2013 and 2017. The patients with gout onset younger than 30 were defined as early-onset group while the others were enrolled as control group. Clinical characteristics and uric acid (UA) indicators were compared between two groups. Among 202 recruited patients, the early-onset group included 36 patients (17.8%). Compared with control group, the early-onset group presented more patients with obesity [13 patients (36.1%) vs. 22 patients (13.3%), 0.05], significantly higher serum UA level [(634±124)μmol/L vs.(527±169)μmol/L] and glomerular load of UA[(7.2±2.8)mg·min(-1)·1.73m(-2) vs. (4.4±2.2)mg·min(-1)·1.73m(-2)] and estimated glomerular filtration rate (GFR) [(83±21)ml·min(-1)·1.73m(-2) vs. (67±21)ml·min(-1)·1.73m(-2)] (all 0.05), lower fractional excretion of UA [4.4% (3.4%,6.1%) vs. 7.2% (5.2%,9.6%),0.05], whereas 24h urinary UA excretion was comparable [(2 788±882)μmol/1.73m(2) vs. (2 645±1 140)μmol/1.73m(2), 0.274]. Subgroup analysis of patients without chronic kidney disease showed significantly lower fractional excretion of UA in the early-onset group [4.5%(3.3%,6.1%) vs. 6.7% (5.1%,8.7%),0.05]. Logistic regression analysis showed that obesity (3.25) and fractional excretion of UA less than 7% (9.01, all 0.05) were risk factors of gout early onset. The gout patients with early-onset younger than 30 present high serum and glomerular load of uric acid which might be due to obesity and relative under-excretion of renal uric acid.
为研究早发性痛风患者的临床特征及肾脏尿酸排泄情况。2013年至2017年期间招募了连续性的原发性痛风住院患者。痛风发病年龄小于30岁的患者被定义为早发组，其余患者作为对照组。比较两组患者的临床特征及尿酸（UA）指标。在202例招募患者中，早发组有36例患者（17.8%）。与对照组相比，早发组肥胖患者更多[13例（36.1%）对22例（13.3%），P<0.05]，血清UA水平显著更高[（634±124）μmol/L对（527±169）μmol/L]、UA肾小球负荷[（7.2±2.8）mg·min⁻¹·1.73m⁻²对（4.4±2.2）mg·min⁻¹·1.73m⁻²]及估算肾小球滤过率（GFR）[（83±21）ml·min⁻¹·1.73m⁻²对（67±21）ml·min⁻¹·1.73m⁻²]（均P<0.05），UA排泄分数更低[4.4%（3.4%，6.1%）对7.2%（5.2%，9.6%），P<0.05]，而24小时尿UA排泄量相当[（2788±882）μmol/1.73m²对（2645±1140）μmol/1.73m²，P=0.274]。对无慢性肾脏病患者的亚组分析显示，早发组UA排泄分数显著更低[4.5%（3.3%，6.1%）对6.7%（5.1%，8.7%），P<0.05]。Logistic回归分析显示，肥胖（比值比3.25）及UA排泄分数低于7%（比值比9.01，均P<0.05）是痛风早发的危险因素。发病年龄小于30岁的早发性痛风患者血清尿酸及肾小球尿酸负荷高，这可能归因于肥胖及肾脏尿酸相对排泄不足。
