大样本前瞻性研究痛风的临床特点
姚中强
摘要(法国)：目的 评价初级医疗机构和风湿病专科在急慢性痛风诊疗行为与2006年欧洲风湿联盟痛风推荐的符合率。
方法 为前瞻性、横断面和描述性随访，由398名全科医生和109名风湿病专家于2008年10月到2009年9月期间随机纳入疑诊痛风、急性痛风和慢性痛风法国患者。初访时完成调查问卷。所有患者初访和3~6月后随访时分别完成自填式问卷。
结果 纳入1003名患者，包括879名(87.6%)男患者[平均年龄(61.6±11.4)岁, 28.1% 肥胖]， 124 (12.4%)女性患者[平均年龄(70.2±11.9)岁, 33.1%肥胖),平均病程( 8.0±8.3)年，高尿酸血症诊断后平均(8.2±8.4)年，平均每年疾病复发(1.9±1.5)次。855例患者符合ACR的痛风分类标准。487 (48.6%)例患者为急性痛风，241 (24.4%)为慢性痛风，19.4%的患者有痛风石，痛风石的发生与病程相关而与性别和慢性肾病无关。主要并发症为高血压 (53.8%)、血脂异常（47.2%)和血糖高/糖尿病(15.0%)。43%的患者有3~5期慢性肾病，但临床医师仅诊断出5.2%。慢性肾病严重度与年龄、性别、高血压和用利尿剂显著相关。
结论 本队列研究有助于研究EULAR关于痛风推荐意见与临床的符合度，有助于日常临床诊疗工作中对痛风的研究，尤其是代谢综合症、其他共患病和发现难治性患者。
附原文：Abstract OBJECTIVES: To assess diagnoses and management of acute and chronic gout in primary care and rheumatology settings relative to 2006 European League Against Rheumatism (EULAR) gout recommendations. Secondary objectives were to describe patient demographics, clinical features, lifestyle. modifications, and short- and mid-term outcomes. METHODS: Prospective, cross-sectional, descriptive survey of patients with chronic gout, acute gout, or suspected gout, included by randomly selected general practitioners (GPs, n=398) and rheumatologists (n=109) between October 2008 and September 2009, in France. At the first visit, a structured questionnaire was completed. Each patient completed self-questionnaires at the first visit and 3 to 6 months later. RESULTS: We included 1003 patients, including 879 (87.6%) males (mean age, 61.6±11.4 years; 28.1% obese) and 124 (12.4%) females (70.2±11.9 years; 33.1% obese). Mean disease duration was 8.0±8.3 years and mean time since hyperuricemia diagnosis 8.2±8.4 years. Mean annual number of flares was 1.9±1.5. ACR criteria for gout were met in 855 pts. Gout was acute in 487 (48.6%) patients and chronic in 241 (24.4%). Tophi (19.4% of patients) were associated with disease duration but not gender or chronic kidney disease (CKD). The main co-morbidities were hypertension (53.8%), dyslipidemia (47.2%), and hyperglycemia/diabetes mellitus (15.0%). CKD 3-5 was present in 43% of patients but was identified by physicians in only 5.2%. CKD severity was significantly associated with age, gender, hypertension, and diuretic use. CONCLUSION: This cohort will prove valuable for addressing the concordance with EULAR recommendations and for future studies of gout in everyday practice, most notably regarding metabolic syndrome, other co-morbidities, and identification of difficult-to-treat patients.
引自： Lioté F, Lancrenon S, Lanz S, Guggenbuhl P, Lambert C, Saraux A, Chiarelli P, Delva C, Aubert JP, Ea HK. GOSPEL: Prospective survey of gout in France. Part I: Design and patient characteristics (n=1003). Joint Bone Spine. 2012 Jan 24. [Epub ahead of print]
