原发性痛风的临床和流行病学研究

摘要

Objective　To evaluate the prevalence of primary gout in Shantou and Beijing area， and understand it's clinical features. Methods　Three epidemiological studies in Chenghai downtown, and the one of study in Beijing were studied. Clinical, laboratory and radiology data were collected and analyzed. Result　 The prevalence of primary gout in Chenghai surveys was 0.17%, 0.15% and 0.26% respectively; no case of primary gout was found in Beijing survey. Among the patients, male to female ratio was 21∶1; average onset age of females was significantly higher than that of males. The numbers of patient in the recent 10 years was increasing. At the first attack, the first metatarsophalangeal joint was involved among 79.7% of all cases; no fourth metatarsophalangeal joint involvement had been found. Hyperlipemia was the most common accompanying abnormal laboratory test (57.1%). Radiographic bone erosion was found in 49.4% patients, most of them, the duration of disease was over 5 years.Conclusion　The prevalence of primary gout was higher in Shantou area than that in Beijing, and it was increasing in the recent 10 years in Shantou area. The difference of geography, climate, food and lifestyle could be responsible for the different prevalence in different area.%目的了解原发性痛风在本地区和北京的流行情况以及其临床特点。方法流行病学调查按国际抗风湿病联盟中国风湿病流行病学调查方法或社区控制风湿病规划规定的程序进行。临床病例记录病人的一般资料、病史、症状、体征、实验室和放射学检查结果，并对所得结果进行统计分析。结果澄海市3次流行病学调查结果显示，原发性痛风患病率分别为0.17%、0.15%和0.26%，北京调查未发现痛风患者。总结临床病例10年共419例中，男女比例21∶1；女性平均发病年龄显著高于男性；10年间病例数分布呈上升的趋势；79.7%的病例以第一跖趾关节为首发部位，而第四跖趾关节未见累及；生化检查以高脂血症，尤其是甘油三酯升高最为多见（57.1%）；X线检查典型的穿凿样改变只占49.4%（207例），且多数见于发病5年以后。结论汕头地区痛风患病率明显高于北京，且有增长趋势。种族和遗传不一定是痛风患病率差异的主要原因，而地理、气候、饮食和生活习惯的影响不能低估。