来源：风湿病与关节炎,2021,10（8）:1-5.

痛风性关节炎患者脂代谢变化及其与免疫、炎症指标和血尿酸的相关性分析（临床研究）

张先恒¹，刘　健²，周　琴¹，陈晓露¹，丁　香¹

　　【摘　要】目的：应用数据挖掘方法分析痛风性关节炎患者脂代谢的变化，并探究其与免疫、炎症指标及血尿酸（UA）的相关性。方法：选取2012年6月至2020年10月在安徽中医药大学第一附属医院风湿科就诊的1412例痛风性关节炎患者的病历资料，依据脂代谢状况，将患者分为脂代谢异常组和脂代谢正常组，使用IBM SPSS Modeler 14.1软件，采用相关性分析、关联规则分析、二元Logistic回归分析等方法进行数据挖掘分析。结果：①1412例痛风性关节炎患者中，男女比例约为21∶1，脂代谢异常1027例（72.73%），UA异常1004例（71.39%）。②脂代谢异常指标值分析显示：总胆固醇（TC）上升389例（37.88%），甘油三酯（TG）上升588例（57.25%），高密度脂蛋白胆固醇（HDL-C）下降514例（50.05%），低密度脂蛋白胆固醇（LDL-C）上升345例（33.59%）。③相关性分析结果显示：总胆固醇（TC）与补体C3（C3）、补体C4（C4）呈正相关（P < 0.05），TG与C3、C4、UA呈正相关（P < 0.05），高密度脂蛋白胆固醇（HDL-C）与免疫球蛋白G（IgG）呈负相关（P < 0.05），低密度脂蛋白胆固醇（LDL-C）与红细胞沉降率（ESR）、免疫球蛋白M（IgM）、C3、C4呈正相关（P < 0.05）。④关联分析结果显示：设置最小置信度为60%、最小支持度为30%，所有提升度 > 1。其中与TC升高关联较高的为hs-CRP、ESR、UA，与TG升高关联较高的为UA，与HDL-C降低关联较高的为hs-CRP、ESR、UA，与LDL-C升高关联较高的为hs-CRP、ESR、UA。⑤Logistic回归分析显示：C3是TC升高的危险因素，C4、UA是TG升高的危险因素，IgA、性别、年龄是HDL-C下降的危险因素，C3、C4是LDL-C升高的危险因素。结论：72.73%的痛风性关节炎患者存在脂代谢紊乱，主要表现为TC、TG、LDL-C升高和HDL-C降低，免疫、炎症反应是脂代谢紊乱的危险因素。

　　【关键词】　痛风性关节炎；脂代谢；免疫炎症；血尿酸；相关性；数据挖掘

Changes of Lipid Metabolism and Its Correlation with Immune,Inflammatory Indexes and Uric Acid in Patients with Gouty Arthritis

ZHANG Xian-heng,LIU Jian,ZHOU Qin,CHEN Xiao-lu,DING Xiang

　　【ABSTRACT】Objective:To analyze the changes of lipid metabolism in patients with gouty arthritis by data mining,and to explore its correlation with immune and inflammatory indexes and uric acid.Methods:The medical records of 1412 patients with gouty arthritis diagnosed in the Rheumatology Department of the First Affiliated Hospital of Anhui University of Chinese Medicine from June 2012 to October 2020 were selected.According to the status of lipid metabolism,the patients were divided into an abnormal lipid metabolism group and a normal lipid metabolism group,using software IBM SPSS Modeler 14.1,correlation analysis,association rule analysis,binary Logistic regression analysis and other methods for data mining analysis.Results:①In 1412 patients with gouty arthritis,the ratio of male to female was about 21∶1,1027 cases（72.73%）had abnormal lipid metabolism and 1004 cases（71.39%）had abnormal blood UA.②The analysis of abnormal indexes of lipid metabolism showed that TC increased in 389 cases（37.88%）;TG increased in 588 cases（57.25%）,HDL-C decreased in 514 cases（50.05%）,and LDL-C increased in 345 cases（33.59%）.③The results of correlation analysis showed that total cholesterol（TC）was positively correlated with C3 and C4（P < 0.05）;TG was positively correlated with C3,C4 and UA（P < 0.05）;HDL-C was negatively correlated with IgG（P < 0.05）;LDL-C was positively correlated with ESR,IgM,C3 and C4（P < 0.05）.④The results of association analysis showed that the minimum confidence was 60%,the minimum support was 30%,and all improvement degrees were more than one.Among them,hs-CRP,ESR and UA were highly associated with the increase of TC;UA was higher associated with the increase of TG;Hs-CRP,ESR and UA were higher associated with the decrease of HDL-C;hs-CRP,ESR and UA were highly correlated with the increase of LDL-C.⑤Logistic regression analysis showed that C3 was a risk factor for elevated TC;C4 and UA are the risk factors for the increase of TG;IgA,sex and age were the risk factors for the decline of HDL-C;C3 and C4 are risk factors for the increase of LDL-C.Conclusion:72.73% of patients with gouty arthritis have lipid metabolism disorder,which is mainly manifested in the increase of TC,TG,LDL-C and the decrease of HDL-C.Immune and inflammatory reactions are the risk factors of lipid metabolism disorder.

　　【Keywords】 gouty arthritis;lipid metabolism;immune inflammation;uric acid;relevance;data mining