CAJ | 학술논문

目的了解原发性痛风患者血尿酸（ sUA）、血脂及血浆胱抑素C（ CysC）的代谢特点，探讨痛风患者易并发心脑血管疾病的可能机制。方法检测326例原发性痛风性关节炎（ GA）患者和210例健康体检者sUA、CysC、胆固醇（ TC）、甘油三酯（ TG）、高密度脂蛋白胆固醇（ HDL-C）、低密度脂蛋白胆固醇（ LDL-C）、极低密度脂蛋白（VLDL）、载脂蛋白A1（apoA1）、载脂蛋白B100（apoB100）、超敏C反应蛋白（hsCRP）浓度并完善血细胞计数，详细收集痛风患者临床资料；比较两组上述指标的差异并分析sUA、CysC与各指标的相关性。结果痛风组sUA、CysC、hsCRP、WBC、中性粒细胞（ GR）、体重指数、TG、TC、VLDL、apoB100、血糖、肌酐和尿素均显著高于正常对照组（ P均＜0.01），而淋巴细胞、HDL则显著低于对照组（ P均＜0.01）。痛风组sUA与年龄、WBC、TG、VLDL、肌酐及CysC 呈显著正相关（ r＝0.24、0.27、0.27、0.33、0.25、0.21， P均＜0.05），与HDL-C呈显著负相关（r＝-0.16，P＜0.01）；痛风组CysC与WBC、GR、单核细胞计数、apoA1、血糖、肌酐、尿素、hsCRP呈显著正相关（r＝0.26、0.20、0.31、0.22、0.46、0.67、0.63、0.33，P均＜0.05），与TC、LDL-C呈显著负相关（ r＝-0.25、-0.27，P均＜0.01）。结论痛风患者血脂异常特点符合致动脉粥样硬化血脂谱的典型特征。痛风患者易出现脂代谢紊乱、易合并心脑血管疾病，可能与高尿酸血症致血管内皮损伤、平滑肌细胞增殖等血管长期慢性炎症反应有关。 CysC可能可作为痛风早期肾功能损害及慢性炎症的判定指标。
목적료해원발성통풍환자혈뇨산（ sUA）、혈지급혈장광억소C（ CysC）적대사특점，탐토통풍환자역병발심뇌혈관질병적가능궤제。방법검측326례원발성통풍성관절염（ GA）환자화210례건강체검자sUA、CysC、담고순（ TC）、감유삼지（ TG）、고밀도지단백담고순（ HDL-C）、저밀도지단백담고순（ LDL-C）、겁저밀도지단백（VLDL）、재지단백A1（apoA1）、재지단백B100（apoB100）、초민C반응단백（hsCRP）농도병완선혈세포계수，상세수집통풍환자림상자료；비교량조상술지표적차이병분석sUA、CysC여각지표적상관성。결과통풍조sUA、CysC、hsCRP、WBC、중성립세포（ GR）、체중지수、TG、TC、VLDL、apoB100、혈당、기항화뇨소균현저고우정상대조조（ P균＜0.01），이림파세포、HDL칙현저저우대조조（ P균＜0.01）。통풍조sUA여년령、WBC、TG、VLDL、기항급CysC 정현저정상관（ r＝0.24、0.27、0.27、0.33、0.25、0.21， P균＜0.05），여HDL-C정현저부상관（r＝-0.16，P＜0.01）；통풍조CysC여WBC、GR、단핵세포계수、apoA1、혈당、기항、뇨소、hsCRP정현저정상관（r＝0.26、0.20、0.31、0.22、0.46、0.67、0.63、0.33，P균＜0.05），여TC、LDL-C정현저부상관（ r＝-0.25、-0.27，P균＜0.01）。결론통풍환자혈지이상특점부합치동맥죽양경화혈지보적전형특정。통풍환자역출현지대사문란、역합병심뇌혈관질병，가능여고뇨산혈증치혈관내피손상、평활기세포증식등혈관장기만성염증반응유관。 CysC가능가작위통풍조기신공능손해급만성염증적판정지표。
Objective To investigate the changes of serum uric acid (sUA),lipids and cystatin C (CysC) of primary gouty arthritis ( GA) patients, and explore the pathogenesis of GA complicating vascular diseases . Methods sUA,CysC, hsCRP, plasma total cholesterol ( TC), triglycerides ( TG), high density lipoprotein-cholesterol ( HDL-C ) , low density lipoprotein-cholesterol ( LDL-C ) , very low density lipoprotein ( VLDL ) , apolipoprotein A1(apoA1) and apolipoprotein B100 (apoB100) were measured in 326 GA cases and 210 healthy control subjects ,blood cell counts were also detected .Clinical data were collected from GA patients .Results sUA, CysC,hsCRP,Body mass index,white blood cell (WBC) counts,neutrophil granulocyte (GR),TG,TC,VLDL, apoB100 ,blood glucose ( GLU ) , serum creatinine and urea nitrogen were significantly increased in GA patients compared with healthy control subjects ( P <0.01 , respectively ) , while lymphocyte counts and HDL-C were significantly decreased in GA patients compared with healthy control subjects (P<0.01,respectively).Significant positive correlations between concentration of sUA and age ,WBC,TG,VLDL,creatinine,CysC (r =0.24,0.27, 0.27,0.33,0.25,0.21,P<0.05,respectively),between CysC and WBC,GR,monocyte,apoA1,GLU,creatinine, urea nitrogen,hsCRP (r=0.26,0.20,0.31,0.22,0.46,0.67,0.63,0.33,P<0.05,respectively) were observed in GA patients,while significant negative correlations between concentration of sUA and HDL -C (r =-0.16,P <0.01 ) , between CysC and TC , LDL-C ( r = -0.25 , -0.27 , P <0.01 , respectively ) were observed . Conclusions Plasma atherogenic lipid profile is changed in GA patients .Hyperuricemia leads to chronic inflammation of vessel due to endothelial cell damage and vascular smooth muscle cell proliferation , so GA can complicating with disorder of lipid metabolism and vascular diseases .CysC might be as a marker of the renal function damage and inflammation .