代謝危險因子與痛風結晶沉積量的相關性：在台灣雙能量電腦斷層的橫斷性研究

Association of Metabolic Risk Factors with Volume of Monosodium Urate Deposition: A Cross-Sectional Dual-Energy Computed Tomography Study in Taiwan

目的：過往研究顯示高尿酸血症與代謝相關危險因子有相關性，但以往少有研究尿酸結晶沉積和代謝相關危險因子的相關性。因此，這篇研究目的在研究和尿酸結晶沉積量相關的代謝危險因子，特別是高血壓、血脂肪與心血管疾患。方法：本研究為單一醫學中心的橫斷性研究，收案對象為符合美國風濕病學會2015年的診斷標準的痛風患者，與符合2016台灣痛風與高尿酸血症指引的無症狀高尿酸血症患者，患者皆接受雙能量電腦斷層以評估四肢的尿酸結晶沉積量。研究以單變量與多變量分析相關因子與痛風結晶量之關聯性。結果：本研究總共有84位病患，其中69位患者符合美國風濕病學會2015年痛風診斷標準，另15位為無症狀高尿酸血症患者符合2016台灣痛風與高尿酸血症指引。在多變量分析中，發現三酸甘油酯與尿酸結晶沉積量的相關性(斯皮爾曼相關係數（0.176 [0 .108; 0.243]）。結論：研究顯示高三酸甘油酯血症和尿酸結晶量有相關性。對於痛風或是高尿酸血症的患者，如果有合併高三酸甘油酯血症會導致較高風險有尿酸結晶沉積，因此對於痛風或高尿酸血症合併高三酸甘油酯血症的患者需要及早注意是否有尿酸結晶沉積。

Objective: Hyperuricemia associated with increased metabolic risk has been previously well studied. However, studies investigating the relationship between tophus deposition and metabolic factors are scarce. Thus, this study aimed to investigate the association of metabolic factors, including hypertension, lipid profile, and cardiovascular disease, to monosodium urate (MSU) volume.Methods: This single-center cross-sectional study included patients who fulfilled the ACR/EULAR 2015 gout classification criteria for gouty arthritis and asymptomatic hyperuricemia patients who fulfilled definition of hyperuricemia in 2016 Taiwan gout and hyperuricemia guideline. All of them received DECT to detect the deposition of the MSU and measure the volume of MSU in all four limbs. Univariate correlation and multivariate analyses were conducted to evaluate the association between the volume of MSU and the metabolic risk factors.Results: A total of 84 patients were recruited; of them, 69 met the 2015 ACR/EULAR gout classification criteria, and the remaining 15 met the 2016 Taiwan gout and hyperuricemia guideline for asymptomatic hyperuricemia. In the multivariate analysis, serum triglyceride was significantly associated with the MSU volume (Spearman correlation coefficient (0.176 [0.108; 0.243])).Conclusions: In this study, hypertriglyceridemia was significantly associated with the volume of MSU deposition. Hypertriglyceridemia leads to a higher risk of tophi deposition in patients with gout or asymptomatic hyperuricemia; therefore, in patients with gout or asymptomatic hyperuricemia comorbid with hypertriglyceridemia, careful and early evaluation of tophi deposition is essential.