痛風患者腎功能下降之相關因素

Factors Associated with Decreased Renal Function in Patients with Gout

目的：本研究的目的是為了確定影響痛風患者腎功能下降之相關因素。方法：回顧性研究單一醫學中心100名痛風患者的臨床特徵。進一步比較腎功能降低（n = 40）和正常腎功能（n = 60）兩組患者間臨床特徵的差異。使用多元羅吉斯回歸模型評估與腎功能降低相關的因素。模型中所使用的變數，是由兩組之間明顯不同的臨床特徵中所挑選出來。結果：與正常腎功能組相比，腎功能降低組（標準化24小時肌酸酐清除率 <90 ml/min/1.73 m2） 初診時年齡較大（56.7 ± 16.4 years vs. 47.7 ± 10.7 years，P = 0.003）、痛風病程較長（15.4 ± 11.0 yearsvs. 10.8 ± 7.0 years，P = 0.021）、較多病患尿液中尿酸排泄 ≤ 800毫克/天（92.5% vs. 68.3%，P =0.004）以及較高的糖尿病盛行率（15.0% vs. 1.7%，P = 0.016）。多元羅吉斯回歸分析顯示痛風病程（OR 1.064，95% CI 1.001–1.132，P = 0.046）、尿液中尿酸排泄 ≤ 800毫克/天（OR 5.306，95%CI 1.282–21.951，P = 0.021）和出現糖尿病（OR 14.222，95% CI 1.256–161.021，P = 0.032）都是痛風患者腎功能降低的重要因素。結論：痛風病程較長、尿液中尿酸排泄減少和糖尿病與痛風患者之腎功能降低有關。

Objectives: The aim of this study was to determine factors that associated with reduced renal function in patients with gout. Methods: Clinical characteristics of 100 gout patients from a single medical center were retrospectively reviewed. Details of patients with reduced renal function (n = 40) and normal renal function (n = 60) were compared. A multivariable logistic regression model was used to estimate factors associated with reduced renal function. The variables used in the model were selected from the significantly different clinical characteristics between two groups. Results: Compared to the normal renal function group, the reduced renal function group (standardized 24- hour creatinine clearance < 90 mL/min/1.73 m2) were older at their initial visit (56.7 ± 16.4 years vs. 47.7 ± 10.7 years, P = 0.003), had a longer disease duration (15.4 ± 11.0 years vs. 10.8 ± 7.0 years, P = 0.021), more urinary uric acid excretion ≤ 800 mg/day (92.5% vs. 68.3%, P = 0.004), and a higher prevalence of diabetes mellitus (15.0% vs. 1.7%, P = 0.016). Multivariable logistic regression analysis showed that the duration of gout (OR 1.064, 95% CI 1.001–1.132, P = 0.046), urinary uric acid excretion ≤ 800 mg/day (OR 5.306, 95% CI 1.282–21.951, P = 0.021), and presence of diabetes mellitus (OR 14.222, 95% CI 1.256– 161.021, P = 0.032) were all significant factors associated with reduced renal function in gout patients. Conclusions: A longer duration of gout, decreased urinary uric acid excretion, and diabetes mellitus are associated with reduced renal function in gout patients.