Analysis Of Risk Factors Associated With Abnormal Lipid Metabolism In Patients With Gout

Research background and purpose:Gouty arthritis is a kind of chronic inflammation caused by the synergistic effect of genetic and environmental factors.It is characterized by the continuous increase of blood uric acid level,which leads to the precipitation and deposition of urate crystals in joints or other tissues,thus causing arthritis.It is a kind of metabolic disease.Urate crystals can not only act on joints,soft tissues,but also on blood vessels,heart,kidney and other target organs.Studies have shown that patients with gout often suffer from metabolism-related complications such as abnormal metabolism of blood fat and blood sugar,and the incidence of obesity,abnormal lipid metabolism,hypertension,diabetes and other diseases in gout patients is increasing year by year.However,the risk factors related to abnormal lipid metabolism caused by hyperuricemia and gout have not been clarified.This paper aims to study the clinical characteristics and related risk factors of gout patients complicated with abnormal lipid metabolism,as well as the risk factors and incidence of gout patients complicated with abnormal lipid metabolism under different levels of blood uric acid,so as to provide clinical basis for systemic damage in gout patients.Materials and Methods:From August 2020 to October 2022,673 patients with gout who visited the outpatient department and inpatient department of rheumatology and immunology of the First Affiliated Hospital of Chengdu Medical College for the first time were collected,and 129 healthy physical examination subjects who underwent physical examination during the same period were included.According to the results of blood lipid detection,gout patients were divided into abnormal lipid metabolism group(409cases)and normal lipid metabolism group(264 cases).General data and laboratory results of gout patients and healthy persons were collected.Multivariate logistic regression was used to analyze the risk factors associated with abnormal lipid metabolism in patients with gouty arthritis,and subjects were divided into quartile groups according to SUA level to analyze the risk factors of gout combined with abnormal lipid metabolism under different levels of blood uric acid.Statistical analysis of the data in this study was carried out using SPSS 26.0 software.Result:1.A total of 673 patients with gout were included in this study,of which male accounted for 94.3%(635 cases)and female accounted for 5.7%(38 cases),ranging from 16 to 93 years old,with a median age of 51 years old.There were 264 cases(39.2%)in the normal lipid metabolism group and 409 cases(60.8%)in the abnormal lipid metabolism group.2.The difference between the abnormal lipid metabolism group and the normal group was analyzed.Compared with the normal group,Age at initial diagnosis,creatinine(CREA),neutrophil percentage(NE%),monocyte percentage(MO%),high density lipoprotein cholesterol(high)in the group with abnormal lipid metabolism density lipoprotein cholesterol(HDLC),apolipoprotein A(APOA)and direct bilirubin(DBIL)were lower than those in normal group(P < 0.05).Hypertension,systolic blood pressure(SBP),diastolic blood pressure(DBP),uric acid,URIC,red blood cell count(RBC),hemoglobin content(HGB),and lymphocyte percentage(RBC)percentage,LY%),rercentage of eosinophilic cells(EO%),basophil percentage(BA%),hematocrit,HCT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),low density lipoprotein cholesterol(low density of lipoprotein cholesterol(LDLC),apoprotein B(APOB)and cholinesterase(CHE)were higher than those in normal group(P < 0.05).3.Multivariate stepwise binary logistic regression analysis was conducted,with abnormal lipid metabolism as the dependent variable.CREA,NE%,MO%,HDLC,DBIL,SBP,DBP,URIC,RBC,HGB,LY%,EO%,BA%,HCT,ALT,AST,ALB,LDLC,APOA,APOB,CHE and Hypertension are covariables.The indicators of CREA,NE%,DBIL,SBP,DBP,and URIC acid were adjusted.The results showed that hypertension,ALT,LDLC,APOB,CHE are risk factors for lipid metabolism abnormality in gout patients,and MO%,HDLDC,APOA are protective factors for lipid metabolism abnormality in gout patients.Blood uric acid was further divided into QI,Q2,Q3 and Q4 groups by quartile,and risk factor analysis was conducted on the four groups respectively.In the Q1,Q2 and Q3 groups,apolipoprotein B was still the risk factor for abnormal lipid metabolism in gout patients.4.Pairwise comparison showed that the proportion of abnormal lipid metabolism in group Q4 was significantly higher than that in other three groups,and that in group Q2 and Q3 was higher than that in group Q1;The TG of group Q4 is higher than that of group Q1 and Q2,and the TG of group Q3 is higher than that of group Q1.The HDLC of group Q2 was higher than that of group Q4.APOA of group Q2 was higher than that of the other three groups.APOB of Q4 group was higher than that of Q1 group,but there was no significant difference among other groups(P > 0.05).There was no significant difference in CHOL,LDLC and LPA among the four groups(P > 0.05).Conclusion:ALT,LDLC,APOB,CHE and hypertension are risk factors of gout patients with abnormal lipid metabolism,while MO%,HDLC and APOA are protective factors of gout patients with abnormal lipid metabolism.After blood uric acid was divided into quartiles,apolipoprotein B was still a risk factor for abnormal lipid metabolism in gout patients in Q1,Q2 and Q3 groups.The abnormal rate of lipid metabolism and TG showed an increasing trend with the increase of SUA,while the increase trend of APOB with SUA was not obvious,and the decrease trend of APOA and HLDC with SUA was not obvious.It is suggested that in gouty arthritis patients,it is recommended to control the blood uric acid at a low level,which is beneficial to reduce the abnormal rate of lipid metabolism.It is not only necessary to control the blood uric acid level within the standard range,but also to closely monitor the changes of blood pressure,LDLC,HDLC,APOA,APOB,ALT and other indicators.It has important guiding significance for the prevention and treatment of clinical complications of gout.