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。

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.