Analysis Of Tophus Formation And Related Risk Factors In Patients With Primary Gout

Research Background and Purpose:Gout is a group of clinical syndrome caused by increased uric acid production and/or excretion disorders,and the most representative complication of chronic gout is the occurrence of tophi.Studies have proved that with the increase of the incidence of tophi,the risk of cardiovascular disease and death of gout patients also increases correspondingly.The purpose of this study was to investigate the clinical characteristics and related risk factors of tophi formation in patients with primary gout,and to provide theoretical basis for early intervention of tophi formation.Materials and Methods:Using a cross-sectional survey method,By using paper questionnaires and electronic medical records,general demographic characteristics(such as age,sex,height,weight,smoking and alcohol consumption)were collected from 1589 patients with primary gout who visited the outpatient and inpatient department of rheumatology and immunology Department of the First Affiliated Hospital of Chengdu Medical College from August 2020 to October 2022 and 130 healthy people who visited the health examination center of our hospital during the same period Hobbies,combined with basic diseases and other basic information),collected blood of healthy physical examination subjects and gout patients,and tested laboratory indicators.The included patients with primary gout were divided into the tophus group(422 cases)and the nontophus group(1167 cases)according to the presence or absence of gouty stones.The serum uric acid level of all gout patients was divided into four groups according to the quartile method,and the other indicators under different serum uric acid levels were compared to determine whether the different effects of the occurrence of gouty stones.Statistical analysis of data in this study was carried out using IBM SPSS Statistics 26.0statistical software,and P<0.05 was considered to be statistically significant.Result:1.Comparison of relevant clinical characteristics between healthy population and gout patient group: Serum uric acid in patients with primary gout was significantly higher than that in healthy subjects(P<0.001).In the gout group,the levels of White Blood Cell(WBC),Neutrophil Count(NE#),serum Creatinine(CREA),Alanine Aminotransferase(ALT),alanine aminotransferase(AST)were significantly higher than those in the control group,Triglyceride(TG),Adenosine Deaminase(ADA)were higher than those in the healthy physical examination group(P<0.05 or P<0.001).The levels of Hemoglobin(HGB),Lymphocyte percentage(LY%),Basophil percentage(BA%),Hematocrit(HCT)in the healthy physical examination group were significantly higher than those in the control group.(P<0.05 or P<0.001).2.Characteristics of patients with gouty stone and possible risk factors:(1)26.6%(422/1589)of gout patients developed gouhite,and the average duration of gouhite was(12.14±7.71)years.Tophus was mainly distributed in the subcutaneous joints of toes,fingers,knees,elbows,auriculae,dorsum of feet,heel,ankle,etc.In the serum uric acid level Q1-Q4 group,the largest number of tophus was formed in the toe joint,and with the increase of uric acid level,the distribution of tophus formation sites also increased.(2)The tophi group had higher age,disease duration,family history of gout,hypertension and diabetes than the non-tophi group.And URIC,NE#,CREA,lipoprotein a(LP-a),Lactate Dehydrogenase(LDH)and c-reactive Protein(C-Reactive Protein,CRP)and Erythrocyte Sedimentation Rate(ESR)were significantly higher in the tophi group than in the non-tophi group(P<0.05 or P<0.001).In the tophi group,HGB,Platelets(PLT),LY%,HCT,Mean Corpusular Hemoglobin Concerntration(MCHC),Albumin(ALB)were significantly lower in the tophi group than in the nontophi group(P<0.05 or P<0.001).There were no significant differences in body mass index(BMI),age of onset of gout,White Blood Cell(WBC),monocyte count,total cholesterol and triglyceride between the two groups(P>0.05).Unifactorial Logistic regression analysis showed that course of disease,serum uric acid,age,history of hypertension,history of diabetes,family history of gout,history of smoking,alkaline phosphatase,serum creatinine,C-reactive protein,erythrocyte sedimentation rate were risk factors for the formation of tophus.After adjusting for family history of gout,gender,diabetes history,smoking history,hypertension history,alkaline phosphatase,serum creatinine,lymphocyte count,C-reactive protein,hemoglobin,erythrocyte sedimentation rate,hematocrit,mean hemoglobin concentration,total protein,albumin,serum uric acid,age,and course of disease were still risk factors for the formation of tophus.(3)The serum uric acid level was divided into quartiles,suggesting that the formation rate of gouhite in group Q4 was significantly higher than that in groups Q1,Q2 and Q3(P<0.01).There were significant differences and correlations in age,disease course,erythrocyte,hemoglobin,erythrocyte distribution width and mean hemoglobin concentration in Q1-Q4 group(P<0.05 or P<0.001).Excluding the indicators with very weak correlation with the formation of tophus(correlation coefficient <0.2),Binary Logistic regression analysis for each group showed that course of disease in group Q1 was a risk factor for the formation of gouty tophus;course of disease and history of hypertension in group Q2 were risk factors for the formation of gouty tophus;course of disease in group Q3 was risk factors for the formation of gouty tophus;and course of disease and red blood cell distribution width in group Q4 were risk factors for the formation of gouty tophus.Conclusion:1.Tophi is a common complication in patients with gout,and patients with tophi are more likely to be complicated with hypertension and diabetes;2..The common site for the formation of tophi is the toe joint,and with the increase of blood uric acid level,the number and distribution of tophi formation also increase gradually.3.Serum uric acid,course of disease,age,history of hypertension,erythrocyte distribution width were risk factors for the formation of gouty tophi,and average hemoglobin concentration was protective factor.