台中縣和平鄉風濕病義診中原住民痛風及高尿酸血症之初步調查報告

The preliminary report of gout and hyperuricemia in Central Taiwan Aborigine

據本科之臨床觀察及原住民口述，本省原住民罹患痛風比率相當高，其中之誘發因素可能與飲酒有關。1992年11月，本科利用在中部和平鄉達觀村為居民作義診活動（以風濕病為主）時以問卷方式，去初步探討當地居民之高尿酸血症、痛風及部份可能之危險因素，在一日之義診問診中，共50位當地原住民接受問卷及臨床與抽血等檢查。結果顯示，在50例中，男性受訪者27例，女性23例，平均年齡為55歲。在50例疑有風濕病患者中，經由臨床及抽血檢查，發現33例(66％)有高尿酸血症，痛風確定者為8例（佔16％）。此8例中，有4例出現痛風石。上述8例皆為男性，男女發生痛風比率有統計上的顯著差異(P<0.01 )。此8例之血中尿酸值為9.6±2.10(mean±S.D)mg/dl與42例非痛風患者其血中尿酸值為7.98±2.16(mean±S.D)( P<0.05 )有統計上的顯著差異。而不論有無痛風原住民之尿酸平均值，皆較本院236例健檢者之尿酸值(5.25±1.58)有明顯地增高(P<0.01)。上述8例痛風患者中，沒有任何1例為長期規則接受降尿酸藥物治療。至於危險因素方面，所有高尿酸血症及痛風患者僅1例有腎功能輕度不足(Creatinine 1.6)，而8例痛風患者中，經常性飲酒者有6例，而飲用酒類為米酒及啤酒。血中鉛離子含量在上述50例之原住民為15.24±3.79μg/dl，較其一般正常人平均值(6.49±1.49)顯著地高(P<0.01)。在本科曾作過之流行病學調查顯示大約0.5％人口得到痛風，而此次研究為一初步之調查，顯示痛風似乎在原住民發生比率較高，症狀較嚴重，與腎功能異常(Creatinine)較無關係，而飲酒可能與原住民之痛風較有關係，至於血中鉛離子濃度增高或遺傳等因素是否與高尿酸血症或痛風有關。未來擬進一進行更大型之研究來瞭解台灣之原住民痛風之盛行率與危險因素。

According to our previous clinical observation, the prevalence rate of gout was higher in Aborigine group than in Taiwanese. It was probably attributed to the heavy alcohol drinking. On November, 1992, the Rheumatology Division set up a free rheumatologic clinic for Da-Guan villagers who are Central Taiwan Aborigine, and during one day peroid, we investigated 50 cases who came mainly with rheumatic complaints. The questionnaire was used to record the medical history, disease severity and risk factors for cases who were diagnosed to have gout or other rheumatic diseases. The results showed, among 50 cases, 8 (16%) were confirmed to have gout and 33 (66%) to have hyperuricemia. All 8 patients with gout were male and it was statistically significant higher in male than in female (P< 0.05). Tophi developed in four of 8 cases and all cases didn't regularly take medicines. The uric acid level in cases with gout was 9.6 ± 2.10 mg/dl, which was significantly increased when comapred with 7.98 ± 2.16 in 42 rheumatic cases other than gout (P< 0.05) and 5.25 ± 1.58 in 236 cases with physical check-up (P< 0.01). The hyperuricemia and gout in Aborigine has no strong relationship with renal insufficiency since only 1 case had mild elevation of creatinine. Six of 8 cases took large amount of liquor during the meal. The most popular liquors are rice wine and beer. The serum lead concenration in local Aborigines (15.24 ± 3.7 μg/dl) was statistically higher than in normal healthy subjects (6.49 ± 1.49) (P< 0.01). The findings suggested Aboriginal group may have higher incidence of gout and hyperuricemia. The risk factors include genetic, alcohol drinking, diet, and lead poisoning etc. The large epidemiologic survey for prevalence rate and risk factors in Aborigine is indicated in the future.