痛风夜间发作是白天的两倍

作者:发布时间:2015/1/28 9:08:44

  痛风夜间发作是白天的两倍

  柴静

  摘要:背景:有一些假说提示痛风常在夜间发作,然而,目前仍缺乏科学的数据支持。

  方法:我们设计了病例交叉对照研究研究急性痛风发作与时间的关系。通过因特网招募并追踪痛风患者一年。参与者需回答以下问题,在痛风发作时:发作时间,症状和征象,用药和痛风发作前24小时及48小时所谓的风险因素情况。根据一天3个8小时并使用条件logistic计算痛风发作的风险比(比如00:00-07:59, 08:00-15:59, 和16:00-23:59)

  结果:本研究共纳入724个痛风患者,一年中共经历1433次发作(第1个8小时、第2个8小时、第3个8小时分别733,310和390次)。发作前没有喝酒、低嘌呤饮食的患者中依然存在这种联系。更进一步,在不同性别、年龄、肥胖、使用利尿剂患者、服用别嘌醇患者、使用秋水仙碱患者、非甾体抗炎药使用患者中这种关系依然存在。

  结论:这些发现提供了第一个前瞻性的证据:夜间及凌晨发作痛风的风险是白天发作的2.4倍。进一步,这些数据支持既往对夜间痛风发作的描述及机制假说。可能对痛风的预防有一些提示。

  附原文:Background: Several plausible mechanisms and anecdotal descriptions suggest that gout attacks often occur at night; however, no scientific data are available.Methods: We conducted a case-crossover study to examine the risk of acute gout attacks in relation to time of the day. Gout patients were prospectively recruited and followed via the Internet for one year. Participants were asked about the following information when experiencing a gout attack: the date and hour of attack onset, symptoms and signs, medication use, and purported risk factors during the 24 and 48 hour periods prior to the gout attack. We calculated the odds ratio (OR) of gout attacks according to three 8-hour time blocks of the day (i.e., 00:00-07:59, 08:00-15:59 [reference], and 16:00-23:59 hours) using conditional logistic regression.Results: Our study included 724 gout patients who experienced a total of 1433 attacks (733, 310, and 390 attacks during the first, second, and third 8-hour time blocks, respectively) over one year. The risk of gout flares in the 8-hour block overnight (00:00-07:59 hours) was 2.36 times higher than in the daytime (08:00-15:59 hours) (OR = 2.36, 95% CI: 2.05 to 2.73). The corresponding OR in the evening (16:00-23:59 hours) was 1.26 (95% CI: 1.07 to 1.48). These associations persisted among those with no alcohol use and in the lowest quintile of purine intake in the 24 hours prior to attack onset. Furthermore, these associations persisted in subgroups according to sex, age group, obesity status, diuretic use, and use of allopurinol, colchicine, and non-steroidal anti-inflammatory drugs.Conclusions: These findings provide the first prospective evidence that the risk of gout attacks during the night and early morning is 2.4 times higher than in the daytime. Further, these data support the purported mechanisms and historical descriptions of the nocturnal onset of gout attacks and may have implications for anti-gout prophylactic measures. © 2014 American College of Rheumatology.

  引自:Hyon K. Choi, JingboNiu, TuhinaNeogi,et al.Nocturnal risk of gout attacks.Arthritis & Rheumatology.Published online December 11, 2014.