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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (5): 915-922. doi: 10.19723/j.issn.1671-167X.2023.05.021

• 论著 • 上一篇    下一篇

急性痛风发作的昼夜差异: 一项男性痛风患者的临床研究

董泓1,2,王丽敏1,王志强1,刘彦卿1,张晓刚1,张明明1,刘娟1,李振彬1,*()   

  1. 1. 中国人民解放军联勤保障部队第九八〇医院风湿免疫科, 石家庄 050082
    2. 河北医科大学研究生院, 石家庄 050011
  • 收稿日期:2022-08-16 出版日期:2023-10-18 发布日期:2023-10-09
  • 通讯作者: 李振彬 E-mail:lizhenbin1962@126.com
  • 基金资助:
    河北省重点研发计划项目(20377713D)

Diurnal differences in acute gout attacks: A clinical study of male gout patients

Hong DONG1,2,Li-min WANG1,Zhi-qiang WANG1,Yan-qing LIU1,Xiao-gang ZHANG1,Ming-ming ZHANG1,Juan LIU1,Zhen-bin LI1,*()   

  1. 1. Department of Rheumatology and Immunology, PLA Joint Logistic Support Force No.980 Hospital, Shijiazhuang 050082, China
    2. The Graduate School, Hebei Medical University, Shijiazhuang 050011, China
  • Received:2022-08-16 Online:2023-10-18 Published:2023-10-09
  • Contact: Zhen-bin LI E-mail:lizhenbin1962@126.com
  • Supported by:
    the Key Research & Development Project of Hebei Province(20377713D)

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摘要：

目的: 观察男性急性痛风发作的昼夜差异, 为临床精准防治提供参考。方法: 采用单中心、横断面研究设计, 选取2021年10月至2022年4月在中国人民解放军联勤保障部队第九八〇医院风湿免疫科门诊确诊为痛风的患者, 记录其本次或最近1次急性痛风发作的信息, 包括发作日期和时间、关节症状和体征、药物使用, 以及就诊当日相关生化检测等指标。分析男性痛风患者急性发作的昼夜时间差异, 进一步对急性痛风发作的昼夜差异与临床特点、生化指标等进行单因素比较及多因素Logistic回归分析。结果: 共纳入100例男性痛风患者, 记录100次急性发作。急性痛风发作人数的昼夜时间分布为: 上午(6:00~11:59, 18, 18%), 下午(12:00~17:59, 11, 11%), 前半夜(18:00~23:59, 22, 22%), 后半夜(0:00~05:59, 49, 49%); 白天(包括上午和下午, 29, 29%), 夜间(包括前半夜和后半夜, 71, 71%)。急性痛风夜间发作的比率明显高于白天, 夜间: 白天约为2.5 : 1。痛风无论是初发还是复发, 也无论病程长短, 其急性发作均存在昼少夜多的昼夜差异。夜间发作者与白天发作者相比, 血尿酸(serum urate, SU)水平更高(P=0.044);是否合并共病在急性痛风发作例次的昼夜构成比差异也具有统计学意义(P=0.028)。经多元Logistic回归分析, SU水平(OR=1.005, 95%CI: 1.001~1.009)、合并共病(OR=3.812, 95%CI: 1.443~10.144)是急性痛风夜间发作的相关因素。结论: 痛风无论初发和复发, 也无论病程长短, 其急性发作均具有以夜间多发为特点的昼夜差异; SU水平增高、存在共病是痛风患者夜间急性发作的相关因素。

关键词: 痛风, 急性发作, 昼夜差异

Abstract:

Objective: To observe the diurnal difference of acute gout attacks in men, and provide reference for accurate clinical prevention and treatment. Methods: Using a single-center, cross-sectional study design, the patients diagnosed with gout in the outpatient department of Rheumatology and Immuno-logy of PLA Joint Logistic Support Force No.980 Hospital from October 2021 to April 2022 were selected. The information about the patient's current/last acute gout attacks (less than 2 weeks from visit), date and time of attacks, joint symptoms and signs, medication use, and relevant biochemical tests on the day of visit was recorded. The diurnal time difference of acute gout attacks in male patients was analyzed, and univariate comparison and multivariate Logistic regression analyses were conducted to compare the diurnal difference of acute gout attacks with clinical characteristics and biochemical indicators. Results: A total of 100 male gout patients were included, and 100 acute attacks were recorded. Diurnal distribution of acute gout attacks: morning (6:00~11:59, 18, 18%), afternoon (12:00~17:59, 11, 11%), the first half of the night (18:00~23:59, 22, 22%), the second half of the night (0:00~05:59, 49, 49%); During the day (included morning and afternoon, 29, 29%) and at night (included the first half of the night and the second half of the night, 71, 71%). The rate of acute gout attack was significantly higher at night than in the day (about 2.5 ∶1). No matter the first or recurrent gout, no matter the duration of the disease, the number of acute gout attacks had the difference of less in the day and more in the night. Serum urate (SU) level was higher in the patients with nocturnal attack than in those with daytime attack (P=0.044). Comorbidities were significantly different in the day-night ratio of the number of acute gout attack (P=0.028). Multiple Logistic regression analysis showed that SU level (OR=1.005, 95%CI: 1.001-1.009) and comorbidities (OR=3.812, 95%CI: 1.443-10.144) were the correlative factors of nocturnal acute gout attacks. Conclusion: No matter the first or recurrent gout, no matter the duration of the disease, it has a diurnal variation characterized by multiple attacks at night, increased SU level and comorbidities are correlative factors for nocturnal acute attack of gout.

Key words: Gout, Acute attack, Diurnal difference

中图分类号: 

  • R593.2

图1

痛风病例筛选流程图"

表1

100例男性痛风患者的一般临床特征"

Items Day Night Total
Essential information
    Age/years, ${\bar x}$±s 36.97±11.84 36.71±13.02 36.78±12.62
    Course of disease/years, M (P25, P75) 2.00 (0.50, 4.00) 2.00 (0.67, 4.00) 2.00 (0.54, 4.00)
Medicationsa
    NSAIDs, n 2 8 10
    Febuxostat, n 10 37 47
    Allopurinol, n 0 3 3
    Benzbromarone, n 2 8 10
    Colchicine, n 1 1 2
    Hypotensive drug, n 1 6 7
    Hypoglycemic drug, n 1 2 3
    Unmedicated, n 6 22 28
Comorbidity
    Hypertension, n 1 6 7
    Coronary heart disease, n 0 2 2
    Hyperlipemia, n 11 34 45
    Liver injury, n 2 5 7
    Urolithiasis, n 1 4 5
    Renal inadequacy, n 0 2 2
    Diabetes, n 1 2 3

表2

昼夜不同时间发作的痛风患者临床相关因素比较"

Correlative factors Day Night χ2 P
Disease course /year
    ≤1 9 19 0.187 0.666
    ＞1 20 52
Attacks, n
    First 4 17 1.279 0.258
    Recurrent 25 54
Comorbidity, n
    Yes 11 44 4.808 0.028
    No 18 27
Medication, n
    Yes 23 49 1.083 0.298
    No 6 22

表3

昼夜不同时间发作痛风患者的生化指标比较"

Items Day Night Z/t P
ESR/(mm/h), M (P25, P75) 5.0 (4.0, 7.0) 5.0 (4.0, 11.5) -0.340a 0.734
CRP/(mg/L), M (P25, P75) 2.49 (0.50, 10.66) 3.96 (0.50, 10.30) -0.049a 0.961
Urea/(mmol/L), M (P25, P75) 5.05 (3.88, 5.93) 4.60 (3.70, 5.50) -1.000a 0.317
Cr/(μmol/L), ${\bar x}$±s 78.75±11.27 81.52±13.37 1.052b 0.343
SU/(μmol/L), ${\bar x}$±s 450.54±128.35 503.85±107.96 1.049b 0.044*
Urinary pH, M (P25, P75) 6.00 (5.50, 6.00) 6.0 (6.0, 6.5) -1.655a 0.098
CHOL/(mmol/L), ${\bar x}$±s 4.70±0.95 5.06±1.13 2.805b 0.156
TG/(mmol/L), M (P25, P75) 1.70 (1.10, 2.46) 1.81 (1.34, 2.57) -0.339a 0.735
HDL/(mmol/L), ${\bar x}$±s 1.18±0.18 1.20±0.24 4.350b 0.598
LDL/(mmol/L), ${\bar x}$±s 3.07±0.64 3.41±0.88 5.091b 0.054
VLDL/(mmol/L), M (P25, P75) 0.79 (0.48, 1.12) 0.82 (0.58, 1.13) -0.173a 0.862

表4

痛风不同分期的生化指标与痛风发作昼夜差异的比较"

Items Day attacks Night attacks Z/t P
ESR/(mm/h)，M (P25, P75)
    Attack 6.5 (5.0, 15.5) 10.0 (4.0, 22.0) -0.433a 0.665
    Intermission 4.0 (3.0, 5.0) 5.0 (1.8, 6.0) -0.322a 0.747
CRP/(mg/L), M (P25, P75)
    Attack 7.87 (2.47, 14.85) 9.48 (2.65, 17.12) -0.298a 0.776
    Intermission 0.50 (0.50, 1.39) 0.50 (0.50, 3.82) -0.249a 0.803
Urinary pH
    Attack, M (P25, P75) 6.0 (5.5, 6.0) 6.0 (6.0, 6.5) -0.518a 0.605
    Intermission, ${\bar x}$±s 6.0±0.5 6.3±0.6 -1.873b 0.069
Cr/(μmol/L), ${\bar x}$±s
    Attack 79.38±10.58 82.38±13.94 -0.757b 0.453
    Intermission 77.92±12.57 80.59±12.89 -0.608b 0.547
Urea/(mmol/L), ${\bar x}$±s
    Attack 4.41±1.27 4.86±1.32 -1.147b 0.260
    Intermission 5.53±1.24 4.61±1.20 -2.279b 0.042*
SU/(μmol/L), ${\bar x}$±s
    Attack 488.13±126.21 515.39±107.22 -0.744b 0.464
    Intermission 400.42±117.97 490.72±109.17 -2.279b 0.034*
CHOL/(mmol/L)
    Attack, ${\bar x}$±s 4.57±1.00 5.18±1.13 -1.706b 0.095
    Intermission, M (P25, P75) 4.60 (4.25, 5.35) 5.07 (3.81, 5.59) 0.422a 0.673
TG/(mmol/L)
    Attack, ${\bar x}$±s 2.17±1.22 1.92±0.66 0.861b 0.394
    Intermission, M (P25, P75) 1.40 (1.08, 2.34) 5.07 (3.81, 5.59) -0.422a 0.673
HDL/(mmol/L), ${\bar x}$±s
    Attack 1.15±0.16 1.17±0.22 -0.337b 0.737
    Intermission 1.21±0.20 1.24±0.27 -0.148b 0.679
LDL /(mmol/L), ${\bar x}$±s
    Attack 2.98±0.73 3.47±0.92 -1.765b 0.085
    Intermission 3.17±0.52 3.32±0.83 -0.578b 0.567
VLDL/(mmol/L)
    Attack, ${\bar x}$±s 1.04±0.57 0.83±0.29 -0.357b 0.721
    Intermission, M (P25, P75) 0.64 (0.47, 1.10) 0.75 (0.52, 1.39) 0.274a 0.786

表5

不同就诊时间的生化指标与痛风发作昼夜差异的比较"

Items Day attacks Night attacks Z/t P
ESR/(mm/h)，M (P25, P75)
    ＜1 week 6.0 (5.0，8.0) 5.0 (1.8，12.3) -0.636a 0.525
    1-2 weeks 4.5 (3.8，6.0) 5.0 (4.0，10.0) -1.092a 0.275
CRP/(mg/L), M (P25, P75)
    ＜1 week 8.13 (0.50，14.98) 6.02 (0.50，10.34) -0.189a 0.855
    1-2 weeks 1.93 (0.50，9.41) 3.68 (0.50，10.31) -0.204a 0.838
Urinary pH, M (P25, P75)
    ＜1 week 6.0 (5.5，6.0) 6.5 (6.0，6.5) -2.629a 0.011*
    1-2 weeks 6.0 (5.5，6.3) 6.0 (5.5，6.5) -0.200a 0.842
Cr/(μmol/L), ${\bar x}$±s
    ＜1 week 76.36±7.21 86.42±14.55 -0.439b 0.666
    1-2 weeks 80.29±13.25 79.31±12.35 -0.408b 0.685
SU/(μmol/L)
    ＜1 week, ${\bar x}$±s 466.36±59.57 486.32±111.11 -0.549b 0.587
    1-2 weeks, M (P25, P75) 382.00 (324.00，577.50) 502.00 (411.00，590.00) -1.985a 0.047*
CHOL/(mmol/L)
    ＜1 week, M (P25, P75) 4.56 (3.81，5.68) 5.52 (4.33，6.62) -1.463a 0.143
    1-2 weeks, ${\bar x}$±s 4.75±0.81 4.91±1.08 -0.537b 0.549
TG/(mmol/L)
    ＜1 week, ${\bar x}$±s 2.13±1.34 1.86±0.60 0.728b 0.473
    1-2 weeks, M (P25, P75) 1.70 (1.06，2.47) 1.78 (1.15，2.86) -0.368a 0.713
HDL/(mmol/L), ${\bar x}$±s
    ＜1 week 1.21±0.22 1.25±0.28 -0.436b 0.666
    1-2 weeks 1.15±0.15 1.18±0.23 -0.408b 0.685
LDL/(mmol/L)
    ＜1 week, M (P25, P75) 2.98 (2.58，3.83) 3.79 (2.80，4.54) -1.511a 0.131
    1-2 weeks, ${\bar x}$±s 3.10±0.45 3.28±0.83 -0.829b 0.411
VLDL/(mmol/L)
    ＜1 week, ${\bar x}$±s 0.97±0.65 0.86±0.27 0.612b 0.546
    1-2 weeks, M (P25, P75) 0.78 (0.51，1.12) 0.81 (0.46，1.18) -0.424a 0.672

表6

急性痛风发作昼夜差异的多因素Logistic回归分析"

Relevant factor Regression coefficient P OR 95%CI
Comorbidity 1.338 0.007 3.812 1.433-10.144
Serum urate 0.005 0.026 1.005 1.001-1.009
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ISSN 1671-167X
CN 11-4691/R
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