The degree of asymptomatic hyperuricemia and the risk of gout. A retrospective analysis of a large cohort
The degree of asymptomatic hyperuricemia and the risk of gout. A retrospective analysis of a large cohort
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DOI：
10.1007/s10067-014-2520-7
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发表时间：
2014-04-01
影响因子：
3.4
通讯作者：
Krause, Ilan
中科院分区：
文献类型：
--
作者：
Duskin-Bitan, Hadar;Cohen, Eytan;Krause, Ilan
本研究旨在探讨男性和女性无症状高尿酸血症程度与痛风发展之间的关系。检索筛查中心的数据库，检索2000-2012年间无症状高尿酸血症（男性> 7.0 mg/dl，女性> 5.6 mg/dl）的所有受试者。我们纳入了之前没有痛风诊断的男性和女性，随访时间至少为5年。在首次就诊时分析痛风风险与高尿酸血症程度的关系。在符合纳入标准的5234名受试者中，4241名首次就诊时为正常尿酸血症，993名为高尿酸血症。平均随访时间为7.5年。34名受试者在最后一次就诊时被诊断为痛风；正常尿酸血症组4例，高尿酸血症组30例（0.1% vs. 3.0%, p < 0.001）。只有一名女性患上了痛风。高尿酸血症组发生痛风的比值比（OR）是正常尿酸血症组的32倍。轻度高尿酸血症男性发生痛风的OR为11.2（置信区间[CI] 3.6-35.2），中度高尿酸血症男性为107.1 (CI 34.2-334.9)，重度高尿酸血症男性为624.8 （CI 134.0- 2913.1）。尿酸水平、噻嗪类药物使用、定期饮酒和肾小球滤过率（eGFR）的多变量分析显示，只有尿酸水平与痛风风险增加有统计学意义。尿酸的绝对水平与患痛风的风险之间有很强的联系，对患有严重高尿酸血症的男性来说尤其如此。建议对这一群体进行监测，因为这一群体患痛风的风险最大。
This study was conducted to examine the relationship between the degree of asymptomatic hyperuricemia and the development of gout, in men and women. The database of a screening center was searched for all subjects with asymptomatic hyperuricemia (> 7.0 mg/dl men, > 5.6 mg/dl women) during 2000-2012. We included men and women without previous diagnosis of gout, and a follow-up of at least 5 years. The risk of gout was analyzed in relation to the degree of hyperuricemia at the first visit. Of the 5,234 subjects who matched the inclusion criteria, 4,241 were normouricemic at their first visit and 993 were hyperuricemic. The mean follow up period was 7.5 years. Gout was diagnosed at the last visit in 34 subjects; four in the normouricemia group and 30 in the hyperuricemia group (0.1 % vs. 3.0 %, p < 0.001). Only one woman developed gout. The odds ratio (OR) for developing gout was 32 times higher in the hyperuricemic group than in the normouricemic group. The OR to develop gout was 11.2 (confidence interval [CI] 3.6-35.2) in men with mild hyperuricemia compared to 107.1 (CI 34.2-334.9) in men with moderate hyperuricemia, and 624.8 (CI 134.0-2,913.1) in men with severe hyperuricemia. Multivariate analysis of uric acid levels, thiazide use, regular alcohol consumption and estimated glomerular filtration rate (eGFR) showed that only the level of uric acid retained statistically significant for increasing the risk of gout. There is a strong association between the absolute level of uric acid and the risk to develop gout, strikingly so for men with severe hyperuricemia. Monitoring is recommended for that group, which poses the greatest risk to develop gout.