陈晓燕 陈斌 栾伟 李挺 陆海峰

摘 要 目的：分析社區65岁及以上老年人血尿酸（UA）升高的检出情况和对高尿酸血症（HUA）的认知情况，为进一步开展社区防治提供策略。方法：以参加体检的3 597名65岁及以上老年人为研究对象，平均年龄（70.08±5.50）岁。其中男性1 652人，女性1 945人。分析老年人群血UA升高情况和对HUA、痛风等相关认知情况。结果：65岁及以上老年人的血UA升高的检出率为25.44%；75岁及以上年龄组女性的检出率显著高于同年龄组的男性（P<0.05）。血UA升高组的经常饮酒率高于血UA正常组（14.54%比11.86，P=0.035）；超重肥胖、血压升高、血脂异常、血肌酐升高、尿素氮升高的检出率也高于血UA正常组，差异均有统计学意义（P<0.05）。两组空腹血糖升高的检出率差异无统计学意义（P>0.05）。在915名血UA升高检出者中有232人知晓自身患有HUA。183名有过痛风发作的患者中，首次发作<65岁者占62.30%，首次发作大脚趾关节者占74.86%，每年痛风发作≥3次者占66.12%，曾发现有肾结石者占53.55%，知晓血UA控制指标者占13.11%，知晓急性痛风发作期间是否能服用降尿酸药物者占7.10%，急性痛风发作期间是否需要多喝水者占78.69%，知晓急性痛风发作期间饮食注意事项者占41.53%。结论：社区老年人血UA升高检出率较高，基层医疗机构在对社区老年人血UA的健康管理方面存在不足，社区老年人对HUA和痛风的认识还存在着较大的问题。应依托区域医疗联合体或医疗中心的资源优势，积极探索分级诊疗模式下的社区老年人群血UA的管理。

关键词 血尿酸升高；社区；老年人；认知

中图分类号：R163 文献标志码：A 文章编号：1006-1533（2021）02-0043-04

*基金项目：上海市社区卫生协会2019社区科研项目（SWX19M04）

Analysis of the detection of elevated blood uric acid and the cognition of hyperuricemia in the elderly people in the community*

CHEN Xiaoyan1， CHEN Bin2**， LUAN Wei3， LI Ting4， LU Haifeng5（1.General Practice Clinic of Pujin Community Health Service Center of Minhang District， Shanghai 210112， China； 2. Department of Public Health of Pujin Community Health Service Center of Minhang District， Shanghai 210112， China； 3. Nursing Department of South Branch of Renji Hospital affiliated to Medical School of Shanghai Jiao Tong University， Shanghai 201199， China； 4. Department of Rheumatology of South Branch of Renji Hospital affiliated to Medical School of Shanghai Jiao Tong University， Shanghai 201199， China； 5. Office of Pujin Community Health Service Center of Minhang District， Shanghai 210112， China）

ABSTRACT Objective： To analyze the detection of elevated blood uric acid （UA） and the cognition of hyperuricemia（HUA） in the elderly people aged 65 years and above in the community， so as to provide strategies for further community prevention and control. Methods： Three thousand five hundred and ninety-seven elderly people aged 65 and above who participated in the physical examination were selected as the research objects， with an average age of （70.08±5.50） years old， among them there were 1 652 males and 1 945 females. The elevated blood UA， the related cognition of HUA and gout in the elderly were analyzed. Results： The detection rate of elevated blood UA in the elderly 65 years and older was 25.44%； the detection rate of women in the age group of 75 years and above was significantly higher than that of men in the same age group（P<0.05）.The rate of regular alcohol consumption in the elevated blood UA group was higher than that in the normal blood UA group （14.54% vs. 11.86， P=0.035）； the detection rates in overweight and obesity， elevated blood pressure， dyslipidemia， elevated blood creatinine， and elevated urea nitrogen were also higher than those in normal blood UA group， and the differences were statistically significant （P<0.05）. There was no significant difference in the detection rate of elevated fasting blood glucose between the two groups （P> 0.05）. Among the 915 people who were detected the increase of blood UA， 232 people knew that they had hyperuricemia. Among 183 patients who had gout attack， 62.30% of them had the first attack under 65 years old， 74.86% had the first attack of big toe joint， and 66.12% had gout attack more than 3 times a year， 53.55% had kidney stones， 13.11% knew the blood UA control indicators， 7.10% knew whether to take UA lowering drugs during acute gout attack， whether they needed to drink more water during an acute gout attack accounted for 78.69%， and 41.53% were aware of dietary precautions during acute gout attacks. Conclusion： The detection rate of elevated blood UA in the elderly in the community is relatively high. Primary medical institutions have insufficient health management of blood UA in the elderly in the community， and there are still big problems in the understanding of HUA and gout among the elderly in the community. Relying on the resource advantages of regional medical consortia or medical centers， the management of blood UA among the elderly in the community under the hierarchical diagnosis and treatment mode should be actively explored.

KEY WORDS elevated blood uric acid； community； elderly people； cognitive

随着我国人民生活水平的不断提高，高尿酸血症（hyperuricemia，HUA）的患病率呈逐年上升趋势。特别是在经济发达的城市和沿海地区，HUA患病率达5%～23.5%，接近西方发达国家水平[1]。2014年的一项全国横断面调查研究表明，我国8.4%的成年人存在HUA，城市患病率明显高于农村，男性患病率高于女性[2]。HUA已成为继高血压、高血脂、高血糖之后的第四“高”。尿酸（UA）是人体嘌呤核苷酸代谢的终产物，任何原因导致体内UA生成量和排泄量失衡或（和）嘌呤代谢失常都可引起血清UA水平升高，HUA是痛风的主要病因[3]。本文旨在了解社区65岁及以上老年人血UA升高的检出情况和对HUA及痛风的认知情况，为社区家庭医生开展HUA的预防和控制提供依据。

1 对象与方法

1.1 对象

选择2019年1-12月在上海市闵行区浦锦社区卫生服务中心参与老年人免费健康体检并填写问卷的3 597例65岁及以上老年人为研究对象，年龄在65～92岁，平均年龄（70.08±5.50）岁。……