台灣年輕痛風患者之臨床表現

Clinical Manifestations of Young Gout Patients in Taiwan

目的：探討年輕痛風患者的表現特徵。方法：自1997年至2001年，我們收集了15個年輕痛風患者，這些病人的年齡皆小於30歲，此外我們另外收集20個小於30歲之年輕正常人作為對照。結果：我們共收集了15個病患，其平均年齡為24.6歲，平均BMI為28.2 kg/m2。7位患者有喝酒史，4位有家族史，最常見的初表現者為踝關節，且在側最常見。平均尿酸為10.5 mg/dl，平均24小時尿酸排除為760 mg。7位病人有尿酸過度排除的現象，平均膽固醇為201 mg/dl，平均三酸甘油酯為383 mg/dl，平均ALT為59 IU/l。BMI、膽固醇、三酸甘油酯、肝功能皆比正常人高。結論：年輕痛風患者比正常年輕人較肥胖，且併有高血脂症，減肥是很重要的。此外，尿酸和血脂代謝的基因異常亦值得進一步探討。

Objective: To determine the clinical characteristics of young gout patients and compare them with control subjects. Methods: Data were collected from gouty patients younger than 30 years old in Kaohsiung Chang Gung Memorial Hospital from 1997 to 2001. The control group was collected from those attending the health examination who were younger than 30 years old in the same time period. The clinical characteristics and biochemical data were recorded and analyzed. Results: Fifteen young gout patients were collected. The mean age was 24.6 ± 3.4 years old. The BMI was 28.2 ± 4.3 kg/m2. Seven patients had alcohol consumption. Four patients had family history of gout. The most common involved joint at first attack was the ankle joint. The left side was more involved than the right side. The mean creatinine clearance was 119.7 ± 27.5 ml/ min. The mean serum uric acid concentration was 10.5 ± 1.7 mg/dl. The mean serum creatinine was 1.1 ± 0.13 mg/dl. Seven patients had uric acid overproduction. The mean 24-hour urinary uric acid excretion was 760 ± 334 mg/d. The mean total cholesterol concentration was 201 ± 28.9 mg/dl. The mean triglyceride level was 383 ± 169 mg/dl. The mean ALT was 59+ 43.9 IU/1. The BMI, cholesterol, triglyceride and ALT were higher than normal control. Conclusion: Young gout patients were obese and had more hyperlipidemia, uric acid overproduction and elevated ALT. Weight reduction is important. It is tempting to postulate the presence of a genetic defect in purine production and lipid metabolism in young gout patients.