台湾における若年性痛風の臨床検討

Abstract

The increasing proportion of patients showing a family history and renal insufficiency in gout suggests that genes for gout may be closely linked with familial juvenile hyperuricemic nephropathy (FJHN), especially for those with precocious onset of gouty attack. This study investigated the clinical features of juvenile gout as well as its possible association with FJHN. A total of 543 cases of juvenile gout with onset of gouty attack earlier than 20 years of age listed in the Hoping Gout Database were enrolled, and 5,269 gouty cases with the onset age between 40 to 50 years were selected as control group. The body weight, height and body mass index in juvenile gout were significantly higher than those in the control group (P<0.0001). The number of joints involved and the percentages of hypertension, diabetes, hyperlipidemia and nephrolithiasis in juvenile gout were significantly lower than those in the control group (P<0.0001). There was no significant difference in the percentage of female gout and tophaceous gout between the two groups. Serum orate level,24-hour urinary uric acid excretion and creatinine clearance in juvenile gout were significantly higher than those in the control group (P<0.0001). The percentage of renal insufficiency in juvenile gout was only 9.8% and was significantly lower than that in the control group (P<0.0001). The percentage of familial aggregation in juvenile gout was about 1.9-fold higher than that in control group (44.3% vs.23.8%, P<0.0001). Among patients with a family history juvenile gout shows a significantly higher proportion of heritage from the father (P<0.0001) and a significant lower proportion of heritage from the sibs and mother than the control group (P<0.0001 for both). In conclusion, juvenile gout is associated with both excessive weight and hereditary background, while the FJHN gene may not be the main gene responsible for juvenile gout in Taiwan.