痛風病人822例之臨床回溯分析

Retrospective Analysis of 822 Gout Patients

我們統計並分析最近二年（79年7月至81年7月）門診及住院822例痛風病人的臨床表現。總計門診有468位，住院有354位（含其它科住院中痛風發作病人）。病人平均痛風發作年齡為47.6歲(14～88)，痛風時間平均5.72年(0～38)。依痛風發作年齡而言，31～60歲佔82.4％最多，而30歲以下發作者佔11％。女性佔所有病患之8.6％。病患之中28.9％有痛風家族史。初次痛風發作54.4％發生於足大姆址基部關節(1st metatarsophalangeal joint)，而在病程中則有75％會犯及此關節。在誘發急性關節炎的因素中，以啤酒、內臟食物、海產最為常見。病人血清尿酸平均值為11.8±1.72 mg/dl（正常範圍2.7～8.3），而33％的痛風病人在本院初診時，血清尿酸檢驗時是屬於正常範圍之內，但若繼續抽血追縱檢查，則幾乎其尿酸值都會上昇。有20.3％是屬於生產過剩型（每天尿液中尿酸排泄量大於800毫克），而總計8.5％病患24小時尿酸排泄量大於1,000毫克。病人之中18.4 ％合併有高血壓，7.4％合併腦血管病變。此外30.7％病人合併有痛風石，而34.7％有尿路結石病史。

We studied 822 Chinese gouty patients treated at Chang Gung Memorial Hospital from July 1990 to July 1992. These included 354 cases of hospitalized patients and 468 cases at outpatient clinics. The mean age of onset was 47.6 (14~88) and mean disease duration before first visit was 5.72 years. Peak incidence was from 31 to 60 of age (82.4%). Young patients below 30 comprised 12%, and females comprised 8.6% of total patients. Family history was postive in 28.9 %. The first metatarsophalangeal joints were initially involved in 54% of patients and in 75% of cases during follow-up. Beer and seafood were important precipitating factors of gouty attack. Mean serum uric acid level was 11.8 ± 1.72 mg/dl. 33% of patients were normouricemic during gouty attack, but follow-up examination usually demonstrated elevated uric acid level. 20.3% of patients were overproducer with a daily urinary uric acid excretion over 800mg (8.5% over 1000 mg/dl). 18.4% of patients had associated hypertension, 7.4% had cerebrovascular disease. Tophi can be found in 30.7%, and urolithiasis in 34.7% of patients.