本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.26640

摘要内容如下：

重要性

美国约有1200万成年人有痛风病史，但血清尿酸盐水平是否有助于预测复发尚不清楚。

目的

在英国有痛风病史的患者中，评估单次血清尿酸盐测量与随后急性痛风发作风险和随后因痛风住院风险的相关性。

设计、设置和参与者

这项回顾性研究纳入了2006年至2010年间在英国发现的有痛风病史的患者，这些患者通过初级保健关联数据医疗记录链接随访至2017年，并通过医院事件统计数据库随访至2020年。

曝光

入组时血清尿酸盐水平。

主要成果和措施

通过住院、门诊和处方/程序记录确定的急性痛风复发率，以及使用负二项回归调整的比率。

结果

在3613例痛风患者（平均年龄60岁；3104[86%]男性），在平均8.3年的随访中有1773例痛风发作。其中，1679例急性痛风发作（95%）发生在基线血清尿酸盐大于或等于6 mg/DL的人群中，1731例（98%）发生在基线血清尿酸盐大于或等于5 mg/DL的人群中。基线尿酸盐水平低于6 mg/DL的参与者的急性痛风发作率为10.6/1000人-年，6.0至6.9 mg/DL的参与者的急性痛风发作率为40.1/1000人-年，7.0至7.9 mg/DL的参与者的急性痛风发作率为82.0/1000人-年，8.0至8.9 mg/DL的参与者的急性痛风发作率为101.3/1000人-年，9.0至9.9 mg/DL的10年间的发作率分别为1.0、3.37、6.93、8.67、10.81和11.42（1.61[1.54-1.68]/mg/DL）。随访期间每1000人-年的住院率为：基线血清尿酸盐低于6 mg/DL的患者为0.18，基线血清尿酸盐为6.0至6.9 mg/DL的患者为0.97，基线血清尿酸盐为7.0至7.9 mg/DL的患者为1.8，基线血清尿酸盐为8.0至8.9 mg/DL的患者为2.2，基线血清尿酸盐为9.0至9.9 mg/DL的患者为6.7，基线血清尿酸盐大于调整年龄、性别和种族后，痛风的住院率分别为1.0、4.70、8.94、10.37、33.92和45.29（1.87[1.57-2.23]/mg/DL）。

结论和相关性

在这项对有痛风病史的患者进行的回顾性研究中，基线时的血清尿酸盐水平与随后痛风发作的风险和痛风复发的住院率相关。这些发现支持在近10年的随访中使用基线血清尿酸盐水平来评估痛风复发的风险。

英文原文如下：

Abstracts

Importance  Approximately 12 million adults in the US have a history of gout, but whether serum urate levels can help predict recurrence is unclear.

Objective  To assess associations of a single serum urate measurement with subsequent risk of acute gout flares and subsequent risk of hospitalizations for gout among patients in the UK with a history of gout.

Design, Setting, and Participants  This retrospective study included patients with a history of gout identified from the UK between 2006 and 2010 who were followed up through Primary Care Linked Data medical record linkage until 2017 and through the Hospital Episode Statistics database until 2020.

Exposures  Serum urate levels at enrollment.

Main Outcome and Measure  Rate of recurrent acute gout, ascertained by hospitalization, outpatient, and prescription/procedure records, and adjusted rate ratios using negative binomial regressions.

Results  Among 3613 patients with gout (mean age, 60 years; 3104 [86%] men), 1773 gout flares occurred over a mean follow-up of 8.3 years. Of these, 1679 acute gout flares (95%) occurred in people with baseline serum urate greater than or equal to 6 mg/dL and 1731 (98%) occurred in people with baseline serum urate greater than or equal to 5 mg/dL. Rates of acute gout flares per 1000 person-years were 10.6 for participants with baseline urate levels less than 6 mg/dL, 40.1 for levels of 6.0 to 6.9 mg/dL, 82.0 for levels of 7.0 to 7.9 mg/dL, 101.3 for levels of 8.0 to 8.9 mg/dL, 125.3 for urate levels of 9.0 to 9.9 mg/dL, and 132.8 for levels greater than or equal to 10 mg/dL. Rate ratio of flares were 1.0, 3.37, 6.93, 8.67, 10.81, and 11.42, respectively, over 10 years (1.61 [1.54-1.68] per mg/dL). Rates of hospitalization per 1000 person-years during follow-up were 0.18 for those with baseline serum urate less than 6 mg/dL, 0.97 for serum urate of 6.0 to 6.9 mg/dL, 1.8 for serum urate of 7.0 to 7.9 mg/dL, 2.2 for serum urate of 8.0 to 8.9 mg/dL, 6.7 for serum urate of 9.0 to 9.9 mg/dL, and 9.7 for serum urate greater than or equal to 10 mg/dL. Rate ratios of hospitalization for gout, adjusting for age, sex, and race were 1.0, 4.70, 8.94, 10.37, 33.92, and 45.29, respectively (1.87 [1.57-2.23] per mg/dL).

Conclusions and Relevance  In this retrospective study of patients with a history of gout, serum urate levels at baseline were associated with the risk of subsequent gout flares and rates of hospitalization for recurrent gout. These findings support using a baseline serum urate level to assess risk of recurrent gout over nearly 10 years of follow-up.

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