Yü T F
Semin Arthritis Rheum. 1977 Feb;6(3):247-55. doi: 10.1016/0049-0172(77)90022-1.
Gouty arthritis in females is relatively infrequent, although the sex ratio may be somewhat altered in different races. A positive family history is relatively prevalent among females whose onset of gout is premenopausal. In those patients with a postmenopausal onset, the incidence of diuretic-associated gout is high. The bimodal distribution of serum urate might be related to some variance of genetic transmission in female gout. Hypertension and coronary heart disease are common coexisting conditions, as is true of gouty arthritis in males. Chronic urinary tract infection dating from previous pregnancies is a frequent complication. The relative prevalence of proteinuria and diminished renal function leads to increased hyperuricemia, with a tendency to a low urinary uric acid output. This explains in part the higher incidence of extensive tophaceous deposition but lower incidence of renal calculi. Diuretics are associated with a higher urine pH, likewise, they reduce the urinary uric acid excretion. This also may contribute to the lower incidence of renal calculi. There may be some statistical support for the low fertility rate among the gouty females. Only two females became pregnant after the onset of gouty arthritis. All other pregnancies occurred before the onset of arthritis. Even then, abnormal pregnancies were relatively frequent. Some hormonal malfunction among the gouty females cannot be discounted. Both renal calculi and tophi are frequent in female gout associated with blood dyscrasias. They may manifest early, preceding the first attack of acute gouty arthritis. In both the male and female secondary gout, the primary underlying disease governs the uric acid metabolism and the clinical symptomatology of gout. The predominant role in pathogenesis is the excessive rate of uric acid production, and its disposal is governed by the different stages of the underlying disease and the treatment. Thus, secondary gout in females appears to be somewhat different from primary gout in females, but not different from secondary gout in males.
女性痛风性关节炎相对较少见，尽管不同种族的性别比例可能会有所改变。痛风发病于绝经前的女性中，家族史阳性较为普遍。在绝经后发病的患者中，利尿剂相关性痛风的发病率较高。女性痛风患者血清尿酸的双峰分布可能与遗传传递的某些差异有关。高血压和冠心病是常见的并存疾病，男性痛风性关节炎患者也是如此。既往妊娠所致的慢性尿路感染是常见的并发症。蛋白尿和肾功能减退的相对患病率导致高尿酸血症增加，尿尿酸排泄量有降低趋势。这部分解释了广泛痛风石沉积发生率较高但肾结石发生率较低的原因。利尿剂会使尿液pH值升高，同样，它们会减少尿尿酸排泄。这也可能是肾结石发生率较低的原因。痛风女性生育率较低可能有一定统计学依据。痛风性关节炎发病后仅有两名女性怀孕。所有其他妊娠均发生在关节炎发病之前。即便如此，异常妊娠也相对常见。痛风女性中存在某些激素功能紊乱是不可忽视的。与血液系统疾病相关的女性痛风中，肾结石和痛风石都很常见。它们可能在急性痛风性关节炎首次发作之前就早早出现。在男性和女性继发性痛风中，原发性基础疾病决定尿酸代谢和痛风的临床症状。发病机制中的主要作用是尿酸产生过多，其排泄受基础疾病的不同阶段和治疗的影响。因此，女性继发性痛风似乎与女性原发性痛风有所不同，但与男性继发性痛风并无差异。
