Gancheva Rada, Koundurdjiev Atanas, Ivanova Mariana, Kundurzhiev Todor, Kolarov Zlatimir
Department of Internal Medicine, Clinic of Rheumatology, Medical University, University Hospital St. Iv. Rilski, Sofia, Bulgaria.
Department of Internal Medicine, Clinic of Nephrology, Medical University, University Hospital St. Ivan Rilski, Sofia, Bulgaria.
Arch Rheumatol. 2019 Jan 28;34(2):176-185. doi: 10.5606/ArchRheumatol.2019.7062. eCollection 2019 Jun.
This study aims to establish cardiovascular risk in obese and non-obese patients in stages of gout by using Framingham risk score (FRS) and transthoracic echocardiography.
This single-center cross-sectional study encompassed 201 patients (160 males, 41 females; mean age 56.9±13 years; range 20 to 89 years) including 52 asymptomatic hyperuricemia, 86 gouty arthritis without tophi, and 63 gouty tophi patients. Body Mass Index (BMI) and FRS were calculated. Left atrium (LA), interventricular septum, posterior wall (PW) of the left ventricle, fractional shortening (FS), mitral annular systolic velocity (S'), mitral annular early diastolic velocity (E') and transmitral to mitral annular early diastolic velocity ratio (E/E') were measured. Data were analyzed by Kolmogorov-Smirnov test, Shapiro-Wilk test, t-test, Mann-Whitney U test, analysis of variance test and multiple linear regression models.
There was no significant difference in FRS, FS, S', E' and E/E' between obese and non-obese patients with asymptomatic hyperuricemia, gouty arthritis without tophi or gouty tophi. Obese patients in the three disease gradations had larger LA (p=0.007, p=0.004, p=0.039) and thicker PW (p=0.002, p=0.037, p=0.007). Increased BMI independently predicted the thickening of the PW in asymptomatic hyperuricemia (R2=0.319), gouty arthritis without tophi (R2=0.093) and gouty tophi (R2=0.068).
Despite the lack of difference in FRS and functional systolic and diastolic parameters between obese and non-obese patients in the spectrum of gout, morphological heart changes were more pronounced in obese patients. In gouty tophi, it is possible that higher urate load together with chronic inflammation contribute for the alterations, as obesity worsens them.
本研究旨在通过使用弗雷明汉风险评分（FRS）和经胸超声心动图来确定痛风各阶段肥胖和非肥胖患者的心血管风险。
这项单中心横断面研究纳入了201例患者（160例男性，41例女性；平均年龄56.9±13岁；范围20至89岁），包括52例无症状高尿酸血症患者、86例无痛风石的痛风性关节炎患者和63例痛风石患者。计算体重指数（BMI）和FRS。测量左心房（LA）、室间隔、左心室后壁（PW）、缩短分数（FS）、二尖瓣环收缩期速度（S'）、二尖瓣环舒张早期速度（E'）以及二尖瓣跨瓣血流速度与二尖瓣环舒张早期速度比值（E/E'）。数据采用柯尔莫哥洛夫-斯米尔诺夫检验、夏皮罗-威尔克检验、t检验、曼-惠特尼U检验、方差分析和多元线性回归模型进行分析。
无症状高尿酸血症、无痛风石的痛风性关节炎或痛风石患者中，肥胖和非肥胖患者在FRS、FS、S'、E'和E/E'方面无显著差异。三个疾病分级中的肥胖患者左心房更大（p = 0.007，p = 0.004，p = 0.039），后壁更厚（p = 0.002，p = 0.037，p = 0.007）。BMI升高独立预测无症状高尿酸血症（R2 = 0.319）、无痛风石的痛风性关节炎（R2 = 0.093）和痛风石（R2 = 0.068）患者后壁增厚。
尽管痛风范围内肥胖和非肥胖患者在FRS以及收缩和舒张功能参数方面没有差异，但肥胖患者的心脏形态变化更为明显。在痛风石患者中，较高的尿酸负荷与慢性炎症可能共同导致这些改变，因为肥胖会使这些改变恶化。
