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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (4): 735-739. doi: 10.19723/j.issn.1671-167X.2025.04.017

• 论著 • 上一篇    下一篇

痛风患者放射学阴性骨侵蚀的相关危险因素

刘伟1, 郭稳2, 过哲3, 李春艳4, 李云龙1, 刘思奇1, 张亮5, 宋慧1,*()   

  1. 1. 首都医科大学附属北京积水潭医院, 国家骨科医学中心, 风湿免疫科, 北京 100035
    2. 首都医科大学附属北京积水潭医院, 国家骨科医学中心, 超声科, 北京 100035
    3. 首都医科大学附属北京积水潭医院, 国家骨科医学中心, 放射科, 北京 100035
    4. 首都医科大学附属北京积水潭医院, 国家骨科医学中心, 检验科, 北京 100035
    5. 首都医科大学附属北京积水潭医院, 国家骨科医学中心, 矫形骨科, 北京 100035
  • 收稿日期:2022-08-12 出版日期:2025-08-18 发布日期:2025-08-02
  • 通讯作者: 宋慧

Risk factors associated with non-radiographic bone erosion in patients with gout

Wei LIU1, Wen GUO2, Zhe GUO3, Chunyan LI4, Yunlong LI1, Siqi LIU1, Liang ZHANG5, Hui SONG1,*()   

  1. 1. Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    2. Department of Ultrasound, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    3. Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    4. Department of Laboratory Tests, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
    5. Department of Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
  • Received:2022-08-12 Online:2025-08-18 Published:2025-08-02
  • Contact: Hui SONG

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摘要：

目的: 分析痛风患者放射学阴性骨侵蚀的相关因素，提高对痛风骨侵蚀的认识，促进骨侵蚀的早期发现。方法: 选择2018年1月至2022年1月北京积水潭医院诊治的痛风患者的病例资料进行回顾性分析，超声可探及骨侵蚀但X线未发现骨侵蚀纳入放射学阴性骨侵蚀组，超声及关节X线均未发现骨侵蚀纳入未探及骨侵蚀组。采用病例对照研究方法，两组按照年龄及性别1 ∶ 2匹配。从一般信息、关节受累特点、实验室指标及并发症等方面进行组间比较。单因素分析P < 0.1的因素纳入多因素分析，采用条件Logistic回归进行多因素分析。结果: 纳入研究的放射学阴性骨侵蚀组共41例，发生骨侵蚀前三位的关节分别是跖趾关节(12例)、踝(10例)、膝(7例)；与其匹配的未探及骨侵蚀组共82例。两组一般信息比较，放射学阴性骨侵蚀组病程更长(P=0.02)，年龄、性别、体重指数及饮酒史组间差异无统计学意义(P>0.05)。两组痛风受累关节特点比较，放射学阴性骨侵蚀组受累关节计数更多(P=0.02)，每年痛风发作≥3次的患者比率更高(P < 0.001)。两组的血尿酸、空腹血糖、胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、肌酐、同型半胱氨酸、白细胞计数及尿pH值等指标差异均无统计学意义(P>0.05)。多因素分析发现，每年痛风发作≥3次是痛风放射学阴性骨侵蚀的独立危险因素，OR (95%CI)为5.139(1.529~17.271)。结论: 每年痛风发作≥3次预示着放射学阴性骨侵蚀的出现，需要更加关注这类痛风患者的达标治疗。

关键词: 痛风, 骨侵蚀, 超声, X射线, 危险因素

Abstract:

Objective: To analyze the factors associated with non-radiographic bone erosion in gout patients, to improve the understanding of bone erosion in gout, and to promote the early detection of bone erosion. Methods: A retrospective analysis was conducted on the medical records of gout patients treated at Beijing Jishuitan Hospital from January 2018 to January 2022. Bone erosion was detectable by ultrasound but not detected by X-ray as non-radiographic bone erosion; no bone erosion was detected by both ultrasound and joint X-ray as undetected bone erosion. A case-control study was used, and the two groups were matched 1 ∶ 2 according to age and sex. The differences between the two groups were compared in terms of general information, joint involvement characteristics, laboratory indicators and complications. In the univariate analysis, P < 0.1 was included in the multivariate analysis, and the conditional Logistic regression was used for the multivariate analysis. P < 0.05 was considered to have statistically significant differences. Results: Among the 41 patients with non-radiographic bone erosion, the top three joints with bone erosion before its occurrence were metatarsophalangeal joint (12 cases), ankle (10 cases), and knee (7 cases). There were 82 patients undetected with bone erosion. There were no significant differences in general information between the two groups (P>0.05), including age, gender, body mass index, and alcohol consumption history. The characteristics of affected joints in the non-radio-graphic bone erosion group were compared with those in the no bone erosion detected, and the former had more affected joints (P=0.02), and a higher proportion of patients with at least 3 attacks of gout per year (P < 0.001). There were no significant differences in serum uric acid, fasting blood glucose, cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, creatinine, homocysteine, white blood cell count, and urine pH between the two groups (P>0.05). The results of multivariate analysis showed that at least 3 flares of gout per year was an independent risk factor for radiologically negative bone erosion in patients with gout, with an OR (95%CI) of 5.139 (1.529-17.271). Conclusion: At least 3 flares of gout per year predicts the occurrence of radiologically negative bone erosion, and these patients should be given more attention to achieving treatment targets.

Key words: Gout, Bone erosion, Ultrasound, X-rays, Risk factors

中图分类号: 

  • R589.7

表1

两组患者一般临床资料比较"

Items Non-radiographic bone erosion (n=41) No bone erosion detected (n=82) P
Age/years 48 (33, 54) 49 (33, 53) 0.180
Gender 0.999
    Male 40 (97.6) 80 (97.6)
    Female 1 (2.4) 2 (2.4)
BMI/ (kg/m2) 27.7 (23.4, 29.4) 27.3 (24.8, 30.1) 0.674
Disease duration/years 6.0 (3.0, 10.0) 3.0 (0.9, 6.0) 0.020
Somking 20 (48.8) 44 (53.7) 0.006
Drinking 19 (46.3) 31 (37.8) 0.272
Family history 8 (19.5) 12 (14.6) 0.002

表2

两组患者痛风累及关节比较"

Items Non-radiographic bone erosion (n=41) No bone erosion detected (n=82) P
Involved joint count 5 (2, 8) 3 (2, 4) 0.020
Flare counts per year≥3 31 (75.6) 39 (47.6) ＜0.001
Foot joint involvement 36 (87.8) 61 (74.4) ＜0.001
Ankle involvement 25 (61.0) 54 (65.9) ＜0.001
Knee involvement 23 (56.1) 45 (54.9) 0.001
Hand joint involvement 17 (41.5) 16 (19.5) 0.268
Elbow involvement 7 (17.1) 7 (8.5) ＜0.227
Tophi 7 (17.1) 7 (8.5) ＜0.227

表3

两组患者实验室指标比较"

Items Non-radiographic bone erosion (n=41) No bone erosion detected (n=82) P
UA /(μmol/L) 498.9±146.6 538.4±141.0 0.282
GLU/ (μmol/L) 5.2 (4.9, 5.7) 5.3 (4.9, 5.7) 0.854
CHOL/(mmol/L) 4.8±1.0 4.9±1.1 0.898
TG/(mmol/L) 1.6 (1.3, 2.3) 1.9 (1.2, 2.8) 0.928
LDL/(mmol/L) 3 (2.6, 3.6) 3.3 (2.4, 3.8) 0.604
HDL/(mmol/L) 1.2±0.3 1.2±0.3 0.341
Cr/(μmol/L) 83 (74, 96) 81 (71, 94) 0.995
HCY/(μmol/L) 17.1 (13.2, 22.4) 17.1 (13.3, 24.8) 0.456
WBC/(×109/L) 8.1 (5.9, 10.4) 8.3 (7.0, 10.4) 0.496
pH 5.9 (5.5, 6.5) 5.5 (5.5, 6.0) 0.850

表4

两组患者合并症比较"

Items Non-radiographic bone erosion (n=41) No bone erosion detected (n=82) P
Hypertension 21 (51.2) 45 (54.9) 0.003
Diabetes mellitus 3 (7.3) 11 (13.4) 0.382
Cardiovascular disease 1 (2.4) 2 (2.4) 0.999
Renal calculi 5 (12.2) 12 (14.6) 0.001

表5

痛风患者放射学阴性骨侵蚀的相关多因素分析"

Variable B SE Wald df P OR (95%CI)
Disease duration 0.085 0.054 2.448 1 0.118 1.088 (0.979-1.210)
Somking 0.113 0.472 0.057 1 0.811 1.119 (0.444-2.825)
Family history 0.406 0.597 0.462 1 0.497 1.501 (0.466-4.835)
Involved joint count 0.042 0.101 0.173 1 0.677 1.043 (0.855-1.272)
Flare counts per year≥3 1.637 0.618 7.006 1 0.008 5.139 (1.529-17.271)
Foot joint involvement 0.403 0.692 0.340 1 0.560 1.497 (0.386-5.807)
Ankle involvement -0.867 0.603 2.066 1 0.151 0.420 (0.129-1.371)
Knee involvement -0.334 0.557 0.360 1 0.549 0.716 (0.240-2.133)
Hypertension -0.211 0.481 0.191 1 0.662 0.810 (0.315-2.081)
Renal calculi -0.670 0.712 0.885 1 0.347 0.512 (0.127-2.066)
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ISSN 1671-167X
CN 11-4691/R
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