| Background and objectiveGout is a form of inflammatory arthritis disease and mainly due to a disorder of purine metabolism,and occurs when its final metabolite,uric acid,crystallizes in the form of monosodium urate,precipitating and forming deposits in joints,on tendons,and in the surrounding tissues.Gout is characterized by recurrent attacks of a red,tender,hot,and swollen,which are mainly caused by the inflammatory responses of the host tissue to the urate crystals deposition.Long-term high uric acid and the deposition of the urate crystals can not only lead to the recurrent flares of gout,joint damage and the formation of tophi,but also associated with various comorbidities,increased mortality.Therefore,understand the importance of treat to target(T2T)urate-lowing strategy and the influencing factors,and individual management of gout patients and comprehensive evaluation the activity of the disease after treatment are more benefit to the treatment to target and improve the outcome of the disease in patients with gout.Present article aims to investigate the influencing factors of treatment to target in gout patients,and to analyze the clinical factors affecting the increase of the urate crystal deposition,and to explore the indicators for the activity of the disease and the post-treatment assessment in patients with gout.Methods1.The basic information of patients with a diagnosis of gout who were being followed-up at Affiliated Northern Jiangsu People's Hospital,Yangzhou University from January 2015 to January 2019.Data were collected onto a standardized case record form and included general conditions(such as the age,the gender,the disease duration,family history,tophi,etc),the comorbidities(such as the hypertension,the diabetes,the hyperlipidemia,BMI and the kidney stones),and the life behavior(such as the smoking and alcoholic intake of people's daily life,the habits of drinking water,and the movement conditions).2.The blood samples of patients with gout were collected for blood routine,liver and kidney function,uric acid,and erythrocyte sedimentation rate;Urine samples were collected for routine urine test;Dual-source energy spectrum CT was used to quantitatively analyze urate deposition in patients with gout.3.The blood routines before and after treatment in controls and gout patients were collected,such as white blood cell count,neutrophil count,lymphocyte count,platelet count,mean platelet volume,etc.,and calculated neutrophils-lymphocytes ratio(NLR)and platelet-lymphocyte ratio(PLR);in addition,collected and measured the erythrocyte sedimentation rate and C-reactive protein in gout patients to evaluate the relationship between NLR and PLR and erythrocyte sedimentation rate and C-reactive proteinResults1.In this group,the target rate of patients with gout was 59.5%after treatment to target for 6 months.Univariate analysis showed that the significant differences in BMI,liver function,disease duration,hyperlipidemia,the compliance of smoking and alcohol consumption,and the compliance of drinking water and the exercise between the standard group of the uric acid and the non-standard group of the uric acid(P<0.05).Logistic regression analysis showed that the abnormal liver function,poor compliance of drinking,poor adherence of drinking water,and excessive exercise(?5 times/week)were the independent risk factors for low target rate of gout(P<0.05)2.The results of the independent sample t test showed that the deposition of monosodium urate crystal in gout patients was significantly increased in gout patients with tophus(P<0.01),family history(P<0.05),hypertension(P<0.05),diabetes(P<0.05),hyperlipemia(P<0.05),renal dysfunction(P<0.05),obesity(BMI?26)(P<0.05),anemia(P<0.05),hyperuricemia(HUA)(P<0.05),and raised counts of white blood cell(P<0.05).3.The levels of NLR and PLR in gout patients were higher than those in healthy controls(P<0.01);Both NLR and PLR were positively correlated with ESR and CRP in patients with gout(r=0.23,P<0.01,r=0.489,P<0.01;r=0.402,P<0.01,r=0.347,P<0.01),whereas there was no correlation of NLR and PLR with the level of serum uric acid,the family history,the tophi and the deposition of the uric crystal in gout patients(P>0.05);Furthermore,the data also showed that NLR and PLR were significantly decreased after treatment when compared with those before treatment(4.37±2.73 vs.3.44±2.63,P<0.01;168.22±94.03 vs.135.87±76.77,P<0.01).In addition,the ROC curve showed that the areas under the curve of NLR was 0.783(95%CI,0.696-0.871)(P=0.000),and the areas under the curve of PLR was 0.701(95%CI,0.604-0.798)(P=0.000),revealed that NLR and PLR were valuable in evaluating the disease activity of gout patients and NLR was more sensitivity in assessing the disease activity of the patients with gout.Conclusion1.After strengthening the health education for patients with gout,the target rate of gout can be significantly increased;Abnormal liver function,poor alcohol consumption compliance,poor adherence of drinking water,and excessive exercise(?5 times/week)were the independent risk factors for low target rate of gout.2.Our study demonstrated that the deposition of urate crystal was associated with hypertension,hyperlipemia,renal dysfunction,obesity,anemia,HUA,raised counts of white blood cell.Therefore,the comorbidities that may affect the increase of urate deposition should be controlled to reduce the acute attack of gout in the course of treatment to target.3.Both NLR and PLR were correlated with gout severity and may be helpful to assess the disease activity and to evaluate the treatment of gout patients. |
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