| BackgroundGout is caused by the body purine metabolic disorder and uric acid excretion reduced. Which in turn led to increased serum uric acid concentration, urate deposition, acute onset of arthritis and accompanied by visceral tissue damage. In severe cases, appear more tophi, joint destruction, loss of joint function, renal insufficiency, cardiovascular disease and others. Its pathogenesis is temporarily unclear, now think is related to genetic, environmental and their energy metabolism disorders. They mainly involving the whole bodyjoints and kidneys. Hyperuricemia is the most important physiological and biochemical basis of diseases. It is the early stages of gout, but the HUA prevalence is much higher than gout. HUA is mainly based on the patient’s serum uric acid values for diagnosis. Whether HUA will progress to gout, it is lack of specificity of predictors. Because of its hidden disease, it did not have enough emphasis on clinical. Organizations have begun to appear urate deposition and metabolism disorder in HUA stage, cause the disorder of internal environment. Whether gout or HUA, often accompanied by high blood pressure, high cholesterol, high blood sugar, known as the "fourth high". They influence each other, and thus evolved into the metabolic syndrome. At present, insufficient understanding of the patient and physician, but harm is caused by the two should not be ignored.The latest study found that adipocytokines, there is a close correlation with the metabolism of the body, such as adiponectin, resistin, interleukin-23, etc. Theyas an important adipokines members involved in the metabolism and inflammation. They may play an important role on the development of HUA and gout disease. We assume that the adipose cytokines involved in the onset of HUA and gout, discuss APN, RES, IL-23in the serum of patients with changes, and analyze the relevant clinical and laboratory indexes, for clinical diagnosis and treatment and prevention of HUA and gout provide new train of thought.ObjectiveDetect serum APN, RES, IL-23 levels in gout, HUA andnormal, analyze their changes and differences and correlation of clinical laboratory index.Analysis the clinical characteristics of patients with gout.Explore the role of adipokines on the pathogenesis of gout and HUA, and its clinical significance.MethodsA case-control study, collected from March to December 2013, the First Affiliated Hospital of Rheumatology outpatient and wards 51 cases of patients with gout, Anhui Medical University, over the same period routine examination 51 case patients with HUA, while select age and sex-matched healthy subjects were 42 cases of normal control group, the laboratory indicators detailed records. Meanwhile serum specimens from all subjects, use enzyme-linked immunosorbent assay detect concentration of serum APN, RES and IL-23. Statistical analyzes were performed using Statistical Package for Social Sciences(stastical package for social science, SPSS) 19.0 software to detect correlation between-group differences and various indicators.Results1.The three groups levels of serum APN,RES and IL-23 and correlation analysis with laboratory indexesAccording to Pearson correlation analysis, the overall analysis of the three groups of serum APN levels seen BMI, UA was negatively correlated(r=-0.253,P=0.002;r=-0.210,P=0.011); Serum RES levels and RBC, HGB was negatively correlated(r=-0.167,P=0.046;r=-0.219,P=0.008), was positively correlated with the WBC, BUN, Cr(r=0.261,P=0.002;r=0.302,P=0.000;r=0.184,P=0.027),Serum IL-23 levels and RBC, HGB was positively correlated(r=-0.212,P=0.011;r=-0.181,P=0.030), was negatively correlated with the PLT(r=0.217,P=0.009),There was no statistically significant difference with the rest of the laboratory indexes.Analyzed separately for each group can be seen:1. Gout group APN and CRP, 24 h uric acid, duration, seizure frequency, the number of joint pain, hypertension were positive correlation( r=0.278,p=0.048; r=0.405,p=0.003 r=0.373,p=0.007;r=0.328,p=0.019;r=0.434,p=0.001;r=0.278,p=0.048),was negatively correlated with the 24 h urine creatinine(r=-0.509,p=0.000);RES and BUN, Cr were positive correlation(r=0.390,p=0.005;r=0.294,p=0.036),was negatively correlated with RBC, HGB(r=-0.546,p=0.000;r=-0.571,p=0.000);IL-23 was positively correlated with PLT(r=0.266,p=0.050);2. HUA group APN was positively correlated with the HGB(r=0.290,p=0.039),And the rest of the various indicators no significant statistical correlation. 3. NC group APN negatively correlated with BMI(r=-0.364,p=0.018);RES and BMI, UA were positive correlation(r=0.302,p=0.050;r=0.307,p=0.048),IL-23 was positively correlated with PLT(r=0.435,p=0.004);2. The three groups laboratory resultsPatients of Gout group, HUA group and NC group, laboratory parameters between the three groups using analysis of variance. Found RBC, HGB, WBC, BMI, BUN, Cr, UA, TC, TG, VLDL there were statistically significant difference(P<0.05). Separate analysis between the two groups can be drawn: 1) NC group and gout group compared: RBC, HGB, WBC, PLT, BUN, Cr and UA, TG, VLDL existence statistically significant difference( t=7.169,p=0.000; t=8.206,p=0.000;t=-4.850,p=0.000; t=-2.394,p=0.019; t=-4.208,p=0.000; t=-3.005,p=0.003;t=-11.508,p=0.000;t=-1.947,p=0.043;t=-2.948,p=0.002);2) NC group and HUA group compared: RBC, BMI, BUN, UA, TC, TG, VLDL existence statistically significant difference( t=-2.369,p=0.020; t=-3.556,p=0.001; t=-3.939,p=0.000;t=-13.733,p=0.000;t=-3.749,p=0.000;t=-4.272,p=0.000;t=-4.252,p=0.000);3) HUA group and gout group compared: RBC, HGB, WBC, BUN, Cr and UA, TC, TG, GLUexistence statistically significant difference(t=9.182,p=0.000;t=9.554,p=0.000;t=-3.900,p=0.000; t=-2.912,p=0.005; t=-2.656,p=0.010; t=-2.289,p=0.025;t=2.002,p=0.048; t=2.756,p=0.007; t=-1.989,p=0.050); Remaining laboratory parameters showed no statistically significant difference3. Clinical performance indicators of gout groupPatients with an average of 8(3,10) days duration, seizure frequency average of 4(2,6)times / year, joint pain and average number of 2(2,4). The joint pain, mainly metatarsophalangeal joint 72.5%, ankle 62.7%, heel joint 58.8%. The existence of a family history of gout patients were56.9%; 52.9%people with hypertension, 9.8%people with diabetes; smokers were58.8%, drinkers were52.9%; High TG37.2%, high VLDL 50.9%, high TC 17.6%,24 hours uric acid excretion reduction51%, excretion normal 45%, excretion increased 3%.The use of drugs to control acute episodes: 33.33% use colchicine, 62.75% use prednisone or methylprednisolone, 60.78% use non-steroidal drugs; Uric acid lowering drug use: 35.29% did not use any of uric acid lowering drugs, 23.53% use Benzbromarone tablets,41.18% using allopurinol. All patients with HUA werenot treated with Uric acid lowering drugs4. Gout group, HUA group, and NC group serum APN, RES, IL- 23 concentration level comparedThe levels of serum APN, RES, IL- 23 there are statistical differences in patients with gout group, HUA group and NC group(χ2=0.008,χ2=0.027,χ2=0.000)。1) The concentration of serum APN: NC group is the highest, gout group centered, HUA group is the lowest( 9525. 84( 4219.19,15813.43) ng/ml vs 7227.63(3812.13,11283.92)ng/ml,5740.15(2994.65,8239.05)ng/ml);NC group and HUA group, HUA group and gout group compared statistically significant difference(Z=-3.011,P=0.003;Z=-2.005,P=0.045);2) The concentration of serum RES: HUA group is the highest, gout group centered,NC group is the lowest( 8530.87( 4666.75,11712.10) pg/ml vs 7104.69(4356.68,10411.52)pg/ml, 5743.55(3982.93,7684.75)pg/ml);HUA group compared with NC group statistically significant difference(Z=-2.675,P=0.007,);3) The concentration of serum IL-23: gout group is the highest, followed HUA group and NC group(112.11(106.68,122.28)pg/ml vs 67.54(37.43,124.89)pg/ml, 63.67(27.67,126.74)pg/ml); NC group and gout group, HUA group and gout group compared statistically significant difference( Z=-3.250, P=0.001; Z=-3.892,P=0.000)。5. Univariate and multivariate regression analysis1) Gout group univariate and multivariate regression analysis: APN and CRP, 24 h uric acid, duration, seizure frequency, the number of joint pain, the prevalence of hypertension was positively correlated(β=25.702,p=0.048;Β=2.279,p=0.003;β=326.898,p=0.007; β =681.522,p=0.019; β =1497.829,p=0.001; β=3234.654,p=0.048);was negatively correlated with the 24 h urine creatinine(β=-1.254,p=0.000). RES and BUN, Cr were positively correlated( β=597.024,p=0.005;β=27.242,p=0.036); was negatively correlated with RBC and HGB(β=-4192.807,p=0.000;β=-150.232,p=0.000). After joining the age, sex, BMI adjusted using multivariate regression analysis, in addition to the APN and CRP, seizure frequency, incidence of hypertension, other indexes are still statistically significant.2) HUA group multiple regression analysis: APN positive correlation with HGB(β=71.111,p=0.039); After joining the age, sex, BMI adjusted using multivariate regression analysis, there does not have a statistically significant correlation;3) NC group multivariate regression analysis: APN and BMI(β=-937.609,p=0.018)was negatively correlation. RES and UA, BMI(β=25.666,p=0.048; β=433.135,p=0.050), IL-23 and PLT(β=0.669,p=0.004)was positive correlation. After joining the age, sex, BMI adjusted using multivariate regression analysis, APN and BMI, IL-23 and PLT still statistically significant.6. Relationship between body mass index(BMI) and Adipocytokines and laboratory parametersAll the research object, according to BMI were divided into the normal weight group(BMI of 25 or less) and obese group(BMI > 25).Compared with normal weight group and obese group, there were significant differences between the APN, UA, TG, VLDL(Z=-1.997, χ2=0.046;p=0.003,t=-3.060;p=0.013,t=-2.517;p=0.004,t=-2.945);APN is higher in normal weight group, UA,TC,VLDL is higher in obese group7. Analysis of serum uric acid abnormal crowd serum APN, RES and IL – 23 levels, and the differences between various clinical indicatorsAccording to serum uric acid levels divided into three groups: mildly elevated group(410 ~ 460 mmol / l), moderately elevated group(460 ~ 528 mmol / l) and severe elevated group(greater than 528 mmol / l), BMI was significantly different between the three groups(F=3.841,p=0.025),compared with mildly elevated group and moderately elevated group, RES, BMI was significant difference(t=2.214,p=0.030,t=-2.575,p=0.012),RES is higher and BMI is lowerin mildly elevated group. Compared with moderately elevated group and severe elevated group, BUN, Cr was significant difference(t=-2.099,p=0.039,t=-3.095,p=0.003), BUN, Cr is higher in severe elevated group. Compared with mildly elevated group and severe elevated group, BMI, TG, VLDL was significant difference(t=-2.423,p=0.018,t=-2.409,p=0.019,t=-2.310,p=0.024), BMI,TG,TC is higher in severe elevated group.8. Pearson analysis between Blood lipids, BMI and UAAnalyze the relationship between the UA and lipid levels. In gout group, UA positively correlated with TG, TC(r=0.355,p=0.011; r=0.320, p=0.022),there is no statistically significant between UA and VLDL, BMI( r=-0.251, p=0.076; r=0.044,p=0.761).In HUA group, UA and VLDL, BMI were positively correlated(r=0.270,p=0.050; r=0.359, p=0.010); there is no statistically significant betweenUA and TG, TC(r=-0.223, p=0.115; r=-0.176,p=0.217).In NC group, UA and BMI were positively correlated(r=-0.512, p=0.001), there is no statistically significant between UA and TG, TC, VLDL(r=-0.248, p=0.114; r=-0.075,p=0.639;r=-0.247, p=0.114)Conclusion1.Diagnosis and treatment of gout and HUA inadequate attention,There is difference in blood, kidney function, blood lipids, UA, BMI among patients with gout and HUA and normal people. Obese people have higher serum UA, TC and VLDL levels than the normal people, Patients with gout and HUA already existing lipid and energy metabolism situation;2. Gout patients Serum levels of IL-23 was higher than it in patients with HUA and normal people, IL-23 levels correlated with the PLT, may only as mediators of inflammation in the body’s inflammatory response;Serum APN, RES concentration in the center,3. HUA patients serum RES concentration is higher, RES levels and BUN, Cr were positively correlated, involved in energy metabolism in the form of affect kidney function.4. Normal people serum APN concentration is higher.The level of serum APN was negatively correlated with BMI. It mainly involved in the pathogenesis of metabolic disorders. Normal people have higher APN level than obese people. It is showed that APN has a protective role in the body’s energy metabolism. |
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