痛风合并症影响痛风的治疗选择、预后及急性发作频率

痛风合并症影响痛风的治疗选择、预后及急性发作频率

张警丰

        摘要 背景：近些年来在很多工业化国家痛风的发病率逐渐上升，并成为炎性关节炎的一个重要病因。痛风的合并症会影响疾病的严重性及其治疗选择。我们的研究内容包括痛风患者的主要特点，痛风的主要治疗选择以及其合并症的发生情况。

        方法：从美国药理评估患者中心大型数据库中选取患者，年龄在20~89岁，至少符合痛风诊断标准（ICD9 274.XX）中的2条，在1996.1.1至2008.12.31曾有相关处方，并随访患者有无痛风急性发作。性别特异的多元回归模型用于评估痛风急性发作的相关因素。

        结果：177637例痛风患者被纳入本研究中，平均年龄55.2岁，男性占75.6%。超过一半的患者（58.1%）有合并症，最常见的是高血压（36.1%）、血脂异常（27.0%）及糖尿病（15.1%）。最常用的治疗药是非选择性非甾体抗炎药（占38.7%）。值得注意的是，39%的痛风患者未接受任何药物治疗。有合并症的痛风患者更可能接受抗痛风药物治疗。急性发作期非甾体抗炎药及秋水仙碱应用增多，29.9%的患者使用了别嘌醇治疗。痛风急性发作风险与心脏代谢性疾病相关，在女性与年龄呈正相关（60~69岁为高发年龄），而在男性则与年龄呈负相关。有这些合并症的女性60%有痛风急性发作（IRR 1.60;1.48-1.74）,而有这些合并症的男性仅10%有痛风急性发作（IRR 1.10；1.06-1.13）。

        结论：痛风的合并症影响痛风的治疗选择、预后及急性发作的频率。心脏代谢性疾病是痛风患者常见的合并症，与痛风急性发作的风险相关。

        附原文：Abstract  Background: Gout prevalence increased in recent years to become one of the most common causes of inflammatory arthritis in most industrialised countries. Comorbidities may affect the disease severity and treatment patterns. We describe the main characteristics of gout patients, gout-related treatment patterns and prevalent comorbidities in a managed care population. Methods: From the large US PharMetrics Patient-Centric Database, patients aged 20-89 with at least 2 claims for a diagnosis of gout (ICD9 274.xx) and related prescriptions between January 1, 1996 and December 31, 2008 were included. Gout flares were ascertained during follow-up. Sex-specific multivariable Poisson regression models were used to assess factors associated with number of flares. Results: 177,637 gout patients were included (mean age 55.2 years; men 75.6%). Overall, more than half (58.1%) had any of the considered comorbidities; hypertension (36.1%), dyslipidemia (27.0%) and diabetes (15.1%) being the most common. Nonselective NSAIDs were the most commonly dispensed (in 38.7% of patients). Notably, 39% of patients did not receive any prescription medication for gout. Patients with comorbidities were significantly more likely to receive anti-gout prescriptions. During an acute episode the prescription of NSAIDs and colchicines increased; and 29.9% of patients received allopurinol. The risk of flares was associated with cardiometabolic comorbidities and older age in women (highest at age 60-69), while in men it decreased by age. Women with these conditions were 60% more likely to have flares (incidence rate ratio, IRR 1.60;1.48-1.74), while men were 10% (IRR 1.10; 1.06-1.13) more likely.Conclusions: Comorbidities affected gout treatment patterns and the occurrence and frequency of acute attacks. Cardiometabolic comorbidities, common in this patients’ population, were associated with an increased risk of flares.

        引自：Paola Primatesta, Estel Plana and Dietrich Rothenbacher. Gout treatment and comorbidities: a retrospective cohort study in a large US managed care population BMC Musculoskeletal Disorders 2011, 12:103