陈刚 胡丹 兰敏 康诗意 谢文光 党万太 周京国

【摘 要】目的：探索原發性痛风患者糖化血红蛋白的变化及意义。方法：收集痛风急性期组（AG组）62例、痛风非急性期组（NAG组）77例、全身性骨关节炎组（OA组）57例患者外周血及实验室检查指标，记录血尿酸、C-反应蛋白、红细胞沉降率、糖化血红蛋白、空腹血糖水平，采用SPSS 17.0软件进行统计分析。结果：痛风患者组血尿酸水平、糖化血红蛋白水平、C-反应蛋白水平升高情况均明显高于OA组。血尿酸在AG组、NAG组、OA组表达差异有统计学意义（F = 65.57，P < 0.01），其在AG组和NAG组表达水平显著高于OA组（P < 0.01）;C-反应蛋白在AG组、NAG组、OA组表达差异有统计学意义（F = 18.51，P < 0.01），其在AG组表达水平显著高于NAG组和OA组（P < 0.01）;红细胞沉降率在AG组、NAG组、OA组表达差异有统计学意义（F = 142.44，P < 0.01），其在AG组表达水平显著高于NAG组和OA组（P < 0.01）;糖化血红蛋白在AG组、NAG组、OA组表达差异有统计学意义（F = 4.25，P = 0.016），其在AG组表达水平显著高于OA组（P < 0.01）;血糖在AG组、NAG组、OA组表达差异有统计学意义（F = 4.25，P = 0.016），其在AG组表达水平显著高于OA组（P < 0.01）。通过Spearman相关性分析发现：在AG组中，C-反应蛋白与红细胞沉降率水平呈正相关（r = 0.607，P < 0.01）;糖化血红蛋白与空腹血糖水平呈正相关（r = 1.0，P < 0.01）。结论：痛风患者中存在显著糖化血红蛋白和空腹血糖水平表达差异，炎症反应可能与糖化血红蛋白和空腹血糖水平密切相关。

【关键词】 痛风;血尿酸;糖化血红蛋白

【ABSTRACT】Objective：To explore the change of glycosylated hemoglobin in patients with primary gout and its significance.Methods：Peripheral blood and laboratory examination indexes were collected from 62 patients with acute gout（the AG group），77 patients with non-acute gout（the NAG group）and 57 patients with systemic osteoarthritis（the OA group）.The levels of serum uric acid，C-reactive protein，erythrocyte sedimentation rate，glycosylated hemoglobin and fasting blood glucose were recorded and analyzed by software SPSS 17.0.Results：The levels of serum uric acid，glycosylated hemoglobin and C-reactive protein in the gout group were significantly higher than those in the OA group.There were significant differences of UA levels in the AG group，the NAG group and the OA group（F = 65.57，P < 0.01），and the levels were significantly higher in the AG group and the NAG group than that in the OA group（P < 0.01）.There were statistical differences in the expression of C-reactive protein in the three groups（F = 18.51，P < 0.01），and it was significantly higher in the AG group than those in the other two groups（P < 0.01）.The expression level of erythrocyte sedimentation rate in the three groups was statistically significant（F = 142.44，P < 0.01）and its expression level was significantly higher in the AG group than those in the other two groups（P < 0.01）.The expression difference of glycosylated hemoglobin in the three groups was statistically significant（F = 4.25，P = 0.016）and it was significantly higher in the AG group than that in the OA group（P < 0.01）.The expression difference of blood glucose in the three groups was statistically significant（F = 4.25，P = 0.016），and its expression level in the AG group was significantly higher that that in the OA group（P < 0.01）.Spearman correlation analysis showed that in the Ag group，C-reactive protein was positively correlated with erythrocyte sedimentation rate（r = 0.607，P < 0.01）;glycosylated hemoglobin was positively correlated with fasting blood glucose（r = 1.0，P < 0.01）.Conclusion：There are significant differences in the expression of glycosylated hemoglobin and fasting blood glucose in gout patients.The inflammatory response may be closely related to their levels.

【Keywords】 gout;blood uric acid;glycosylated hemoglobin

痛风是嘌呤代谢紊乱或尿酸排泄障碍引起血尿酸（UA）增高，尿酸盐（MSU）结晶析出并沉积在关节及组织的临床综合征，临床表现为反复关节红、肿、热、痛及功能障碍，甚至关节致残性毁损、尿酸性肾病及肾功能衰竭[1]，其患病率受多种因素的影响。高尿酸血症是痛风的重要生化基础[2]。

研究表明，UA升高常与肥胖、高血压、高血糖、血脂紊乱等代谢综合征等相伴随[3]，目前认为其原因为UA水平与胰岛素抵抗呈正相关[4]，UA蓄积于胰岛，则可导致β细胞功能损害，影响胰岛素分泌引起糖代谢紊乱，从而引起糖尿病发生[5-6]。

糖化血红蛋白（GHb）是指糖与血红蛋白的结合物，反映出人体2～3个月的血糖状态，是糖尿病诊断的重要指标。痛风作为一种常见的代谢性疾病，UA增高会引起胰岛素抵抗，那么痛风患者GHb是否存在异常表达？本课题通过检测原发性痛风患者及全身性骨关节炎（osteoarthritis，OA）患者UA、C-反应蛋白（CRP）、红细胞沉降率（ESR）、GHb以及空腹血糖水平表达，分析GHb在痛风中差异及与UA、CRP、ESR的关系，探讨GHb在痛风中的意义。……