痛風(fēng)患者血尿酸和炎性因子水平變化及相關(guān)性分析

查旭雯 夏光云

摘要：目的? 探討痛風(fēng)患者血尿酸水平以及炎性因子C反應(yīng)蛋白（CRP）、白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）水平的變化，并對(duì)其進(jìn)行相關(guān)性分析。方法? 選擇2018年5月～2019年2月我院收治的52例痛風(fēng)患者作為患者組，選取同期52名健康受試者作為對(duì)照組。檢測(cè)兩組受試者的血尿酸及CRP、IL-6、TNF-α的水平;采用Pearson相關(guān)分析評(píng)估血尿酸與炎性因子水平的相關(guān)性;采用ROC曲線法評(píng)估CRP、IL-6、TNF-α聯(lián)合血尿酸對(duì)痛風(fēng)診斷的曲線下方面積（AUC）、靈敏度和特異性。結(jié)果? 患者組血尿酸、CRP、IL-6、TNF-α水平均高于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。血尿酸與CRP（r=0.193，P=0.050）、IL-6（r=0.225，P=0.021）、TNF-α（r=0.342，P=0.000）的水平均呈正相關(guān)關(guān)系。CRP、IL-6、TNF-α聯(lián)合血尿酸水平診斷痛風(fēng)的AUC面積分別為0.824（靈敏度為86.30%，特異性為67.30%）、0.811（靈敏度為80.40%，特異性為73.10%）、0.989（靈敏度為100.00%，特異性為96.20%）。結(jié)論? 痛風(fēng)患者升高的血尿酸水平可能與循環(huán)中的炎性因子密切相關(guān)，且炎性因子的水平對(duì)于痛風(fēng)的診斷具有一定的指導(dǎo)意義。

關(guān)鍵詞：痛風(fēng);尿酸;炎性因子;診斷

中圖分類(lèi)號(hào)：R589.7? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻(xiàn)標(biāo)識(shí)碼：A? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2019.15.058

文章編號(hào)：1006-1959（2019）15-0170-03

Abstract：Objective? To investigate the changes of serum uric acid level， inflammatory factor C-reactive protein （CRP）， interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） levels in patients with gout， and to analyze their correlation.Methods? A total of 52 patients with gout admitted to our hospital from May 2018 to February 2019 were enrolled as the control group. 52 healthy subjects were selected as the control group. The levels of serum uric acid and CRP， IL-6 and TNF-α were measured in the two groups. The correlation between serum uric acid and inflammatory factors was evaluated by Pearson correlation analysis. The area under the curve （AUC）， sensitivity and specificity of CRP， IL-6， TNF-α combined with blood uric acid for gout diagnosis were evaluated by ROC curve method.Results? The levels of serum uric acid， CRP， IL-6 and TNF-α in the patients were higher than those in the control group， and the difference was statistically significant （P<0.05）. There was a positive correlation between serum uric acid and CRP （r=0.193，P=0.050），IL-6 （r=0.225，P=0.021）， and TNF-α （r=0.342，P=0.000）. The AUC areas of CRP， IL-6， TNF-α combined with blood uric acid level for the diagnosis of gout were 0.824 （sensitivity 86.30%， specificity 67.30%）， 0.811 （sensitivity 80.40%， specificity 73.10%）， 0.989 （ the sensitivity is 100.00% and the specificity is 96.20%）.Conclusion? The elevated blood uric acid level in gout patients may be closely related to inflammatory factors in the circulation， and the level of inflammatory factors has certain guiding significance for the diagnosis of gout.

綜上所述，痛風(fēng)患者升高的血尿酸水平可能與循環(huán)中的炎性因子存在聯(lián)系，且炎性因子的水平對(duì)于痛風(fēng)的診斷具有一定的指導(dǎo)意義。

參考文獻(xiàn)：

[1]Ragab G，Elshahaly M，Bardin T.Gout：An old disease in new perspective-A review[J].Journal of Advanced Research，2017，8（5）：495.

[2]So AK，Martinon F.Inflammation in gout：mechanisms and therapeutic targets[J].Nature Reviews Rheumatology，2017，13（11）：639.

[3]Shiozawa A，Buysman EK，Korrer S.Serum uric acid levels and the risk of flares among gout patients in a US managed care setting[J].Current Medical Research&Opinion，2017，33（1）：117-124.

[4]Shiozawa A，Szabo SM，Bolzani A，et al.Serum Uric Acid and the Risk of Incident and Recurrent Gout：A Systematic Review[J].Journal of Rheumatology，2017，44（3）：388.

[5]Schlesinger N.Management of acute and chronic gouty arthritis：present state-of-the-art[J].Drugs，2004，64（21）：2399-2416.

[6]Baumgartner S，Yeh LT，Shen Z，et al.The Effect of Lesinurad in Combination With Allopurinol on Serum Uric Acid Levels in Patients With Gout[J].Journal of Clinical Pharmacology，2018，58（9）：1164-1170.

[7]Cavalcanti NG，Marques CD，Tu LEL，et al.Cytokine Profile in Gout：Inflammation Driven by IL-6 and IL-18[J].Immunological Investigations，2016，45（5）：1-13.

[8]劉圳奮，馬紅霞，李秀寧，等.痛風(fēng)性關(guān)節(jié)炎與高尿酸血癥炎性細(xì)胞因子水平比較[J].西部中醫(yī)藥，2014，27（8）：157-158.

[9]Chen YH，Hsieh SC，Chen WY，et al.Spontaneous resolution of acute gouty arthritis is associated with rapid induction of the anti-inflammatory factors TGFβ1，IL-10 and soluble TNF receptors and the intracellular cytokine negative regulators CIS and SOCS3[J].Annals of the Rheumatic Diseases，2011，70（9）：1655-1663.

[10]Nonaka F，Migita K，Haramura T，et al.Colchicine-responsive protracted gouty arthritis with systemic inflammatory reactions[J].Japanese Journal of Rheumatology，2014，24（3）：540-543.

[11]Jiang X，Li M，Yang Q，et al.Oxidized Low Density Lipoprotein and Inflammation in Gout Patients[J].Cell Biochemistry&Biophysics，2014，69（1）：65-69.

收稿日期：2019-3-19;修回日期：2019-3-29

編輯/楊倩