Analysis Of Related Risk Factors Of Liver And Kidney Dysfunction In Patients With Gout And Evaluation Of Traditional Chinese Medicine Efficacy

Objective: To explore the clinical characteristics of liver and kidney function abnormalities in gout patients,related risk factors and the effect of TCM treatment,to deepen the understanding of the mechanism and risk factors of liver and kidney function abnormalities in gout patients,and also to provide some basis for the clinical treatment of Chinese and Western medicine together.METHODS: 270 patients with gouty arthritis hospitalized in the Department of Rheumatology and Immunology of Tianjin University of Traditional Chinese Medicine from January 2017 to December 2021 were collected and divided into normal liver function group,abnormal liver function group,normal kidney function group and abnormal kidney function group.General information,biochemical and other relevant laboratory indices,TCM symptoms and tongue and pulse,and imaging findings of the patients were collected.The collected data were entered into Excel,a database was established,and statistical software was applied for statistical analysis.Results:1.Overall clinical characteristics of gout patients: 270 patients were included in this study,of whom 248(91.9%)were male and 22(8.1%)were female;the overall mean age of patients was 51.62±15.79 years,with an age range of 17-90 years;the mean height was1.73±0.06 m,the mean weight was 81.43±15.77 kg,and the BMI was overweight and obese in 215 patients(79.6%).Previous smoking was found in 103 patients(38.1%),and 114patients(42.2%)had a history of alcohol consumption.226 patients(83.7%)had a combination of abnormal lipid metabolism,158 patients(58.5%)had fatty liver,68 patients(25.2%)had abnormal liver function,and 118 patients(43.7%)had abnormal renal function.2.Analysis of clinical characteristics and related risk factors of patients with gout combined with abnormal liver function: there were 68 patients in the abnormal liver function group,with a mean age of 43.43±12.94 years,66(97.1%)males and 2(2.9%)females.Compared with the normal liver function group,the proportion of female patients with gout combined with abnormal liver function was lower,only 2.9%,and the number of patients with overweight or obese BMI was significantly higher than that of the normal group,and the number of patients with previous smoking,combined hyperlipidemia,fatty liver and abnormal lipid metabolism was significantly higher than that of the normal group.After correlation analysis,the results showed that ALT levels in gout patients were positively correlated with total cholesterol,triglycerides,LDL,glomerular filtration rate,hemoglobin,and ferritin levels,and negatively correlated with urea and creatinine;AST levels were positively correlated with total cholesterol,triglycerides,LDL,glomerular filtration rate,hemoglobin,and ferritin levels.Univariate analysis of these indicators screened out elevated total cholesterol,elevated triglycerides,elevated LDL,elevated hemoglobin,and elevated ferritin as influential factors for abnormal liver function in gout patients,and further binary logistic regression analysis showed that combined hyperlipidemia,elevated triglycerides,elevated ferritin,and elevated hemoglobin were risk factors for abnormal liver function in gout patients.3.Analysis of clinical characteristics and related risk factors of combined renal function abnormalities in gout patients: there were 118 patients in the renal function abnormalities group,with an average age of 61.20±14.74 years,104(88.1%)males and 14(11.9%)females.Compared with the normal renal function group,the BMI of the abnormal renal function group was significantly lower than that of the normal group,while the age was significantly higher than that of the normal group;in terms of comorbidities,the proportion of combined coronary heart disease and hypertension was significantly higher than that of the normal group.The results of correlation analysis showed that the glomerular filtration rate levels of gout patients were positively correlated with ALT,AST,total cholesterol,triglycerides,hemoglobin,24-hour uric acid,BMI,ferritin,total protein,and albumin levels,and negatively correlated with age,disease duration,urea,and creatinine;creatinine levels were positively correlated with blood uric acid at onset,maximum blood uric acid,and urea levels,and positively correlated with albumin,hemoglobin,and glomerular filtration rate,total cholesterol,and ALT levels were negatively correlated.Univariate analysis of these indicators showed that elevated ALT,elevated ferritin,elevated hemoglobin,and elevated 24-hour uric acid were influential factors for abnormal renal function in gout patients,and further binary logistic regression analysis showed that combined hypertension was a risk factor for abnormal liver function in gout patients.4.Evaluation of the effect of TCM treatment of gout combined with abnormal liver and kidney function: ALT,AST and blood uric acid levels in the group with abnormal liver function decreased significantly after TCM treatment compared with those before treatment.There were 20 cured patients,20 effective cases and 7 ineffective cases,and the total effective rate was 85.10%.The creatinine,glomerular filtration rate and blood uric acid levels in the abnormal renal function group were significantly better after TCM treatment than before treatment.The total effective rate was 72.7%.42 patients were cured,22 were effective and24 were ineffective.Conclusion:The proportion of gout patients with abnormal liver and kidney function is high.Clinical attention should be paid to lipid metabolism,ferritin level and blood pressure control to reduce the risk of liver and kidney damage,and the clinical use of Chinese medicine to treat such patients is feasible,effective and worth promoting.