广西农村地区痛风及痛风石饮食影响因素研究

发布时间：2018-06-19 16:56

本文选题：农村地区 + 痛风　；参考：《广西医科大学》2017年硕士论文

【摘要】：研究背景痛风是一种常见的慢性营养代谢性疾病,尤其是在中老年男性多见,在全世界都有发病,既往报道我国痛风患病率相对较低,然而,近年来随着我国经济实力的日益加强,人民生活的不断改善,痛风患病状况较之以往发生了明显的改变。2014年广西大化某乡镇发现多名关节畸形患者,被媒体称为“大化怪病”,医疗主管部门组织医疗专家完善相关检查后,诊断这些都是痛风伴发痛风石引起的严重关节畸形的患者,可见痛风及痛风石对广西农村地区居民造成了一定的经济及健康负担。研究目的(1)初步了解广西农村地区痛风患者患病的膳食相关影响因素,为广西农村地区的痛风预防提供膳食指导意见。(2)初步了解广西农村地区痛风患者罹患痛风石的膳食影响因素,为广西农村地区的痛风患者预防痛风石的发生提供膳食指导意见。研究方法采用病例-对照的研究方法,以广西的三江(内陆地区)、大化(大石山区)、合浦(沿海地区)作为调查点,通过当地医院治疗信息搜索痛风患者并与之电话联系初步确定痛风组调查人员,按1:1匹配随机抽取当地与痛风研究对象年龄相近(±4岁),性别相同,居住地相近的非痛风居民初步定为对照组人群,以上所有调查对象完成现场问卷、体检后,最后通过获得临床主治医师以上资格的专科医师按1977年美国痛风协会诊断标准,根据相关检查结果确定病例组及对照组研究对象。按照食物频率法调查痛风患者既往食物摄入情况。通过相互比较,探索影响广西农村地区痛风患病的相关因素。根据最后收集到的数据,按是否有痛风石将所有痛风患者分成痛风石组和无痛风石组,按照非匹配的原则进行分析比较,探索影响广西农村地区痛风居民痛风石形成的相关因素。研究结果1、痛风组与对照组对比(1)病例组和对照组的各类食物消费量比较:病例组的多种食物平均消费量高于对照组,其中两组间肉类、嘌呤、低度酒、啤酒、米酒、高度酒和总酒精的消费量的差异有统计学意义(p0.05)。(2)比较食物和酒类酒精摄入量暴露率:根据调查中各类食物的摄入情况及2016年中国居民膳食指南推荐摄入量,将各类食物摄入情况进行比较,经过单因素分析,结果显示:病例组和对照组在内脏、猪肉、嘌呤摄入量差异有统计学意义(p0.05);米酒、啤酒、低度酒和总酒精摄入量差异也有统计学意义(p0.05)。(3)多种模型的logistics回归分析。结果如下:模型1(纳入年龄、职业、文化程度、家庭年收入、痛风家族史、bmi、肉类、内脏作为模型)显示过量摄入内脏和肉类增加痛风的风险;模型2(纳入年龄、职业、文化程度、家庭年收入、痛风家族史、bmi、肉类、内脏、啤酒、米酒作为模型)显示摄入内脏、肉类、啤酒和米酒过量,痛风的危险度增加,其中内脏摄入量≥50g/d的研究对象其患痛风的风险是摄入量25g/d研究对象的4.5倍,米酒过量摄入(换算成酒精25g/d)患病风险是不喝米酒的4.0倍;模型3(纳入年龄、职业、文化程度、家庭年收入、痛风家族史、bmi、总嘌呤、总酒精摄入量作为模型)显示,各类食物换算成嘌呤后,总嘌呤摄入量≥1000mg/d,酒精总摄入量25g/d时罹患痛风的风险明显增加。2、痛风石组与无痛风石组对比(1)各类食物消费情况比较显示无痛风石组的主食和鱼类平均摄入量均高于痛风石组,差异具有统计学意义(P0.05)。(2)各类食物分层比较按照《中国居民膳食指南2016》推荐摄入量并结合食物实际摄入情况,对各类食物消费量进行分层,单因素分析结果显示主食消费量≥250g/d组和水果消费量≥100g/d组均可降低患痛风石的风险。(3)多因素logistic回归分析年龄、民族、痛风病程、主食和水果摄入量与痛风石患病风险的关系显示,在校正了性别、职业、吸烟、痛风家族史、血尿酸水平、蔬菜、水果、畜禽肉类、蛋类、内脏和酒精摄入量等因素后,壮族、痛风病程≥6年和≥9年均可增加痛风石的患病风险;主食摄入量≥250g/d组和水果摄入量≥100g/d组均可降低痛风石的患病风险。结论1、主要发现可能的痛风发病相关因素:根据不同的模型logistic回归结果显示,内脏摄入量≥50g/d的研究对象罹患痛风的风险是摄入量25g/d研究对象的4.5倍;米酒摄入过量(25g/d)罹患痛风的风险是不喝米酒的4.0倍;嘌呤摄入量≥1000mg/d及酒精总摄入量25g/d时罹患痛风的风险明显增加。2、主要发现可能与痛风石形成有关的因素:本研究发现痛风患者痛风石的患病风险与痛风患病的病程长短有关,病程大于6年以上患者其罹患痛风石的风险显著增加;谷薯类主食摄入量≥250g/d(推荐摄入量250~400g/d)、水果摄入量≥100g/d为广西农村地区居民痛风石形成的保护性因素。
[Abstract]:Background gout is a common chronic nutritional and metabolic disease, especially in the middle and old age men. The prevalence of gout is relatively low in the past. However, in recent years, with the increasing economic strength of our country and the improvement of the people's life, the situation of gout is more obvious than in the past. In.2014, Guangxi Dahua County found a number of joint deformities in a township, which was referred to as "strange disease" by the media. After the medical authorities organized medical experts to improve the related examination, they were diagnosed as patients with severe joint deformities caused by gout with gout, and the pain wind and gout stones were caused to the residents in the rural areas of Guangxi. A certain economic and health burden. Research objectives (1) a preliminary understanding of the dietary related factors of gout patients in rural areas of Guangxi, and to provide dietary guidance for gout prevention in rural areas of Guangxi. (2) a preliminary understanding of the dietary influence factors of gout in rural areas of Guangxi for gout suffering from gout in rural areas of Guangxi. To prevent the occurrence of gout, dietary guidance was provided. The study method used a case control study method, which was used in Sanjiang (inland area) of Guangxi, Dahua (Dashi mountain) and Hepu (coastal area) as the investigation point. The local hospital treatment information was used to search gout patients and to make a preliminary determination of the gout group, according to 1:1 The non gout residents with the same age (4 years old), the same sex and the same living area were randomly selected as the control group. All of the above subjects completed the questionnaire, and after the physical examination, the 1977 American gout Association diagnostic standard was adopted by the specialist who was qualified by the clinical physician. Determine the case group and the control group according to the results of the related examination. Investigate the past food intake of gout patients according to the food frequency method. Through comparison, explore the related factors affecting the gout in the rural areas of Guangxi. According to the data collected at the end, all gout patients are divided into gout groups according to whether there is a sore stone or not. Painless wind stone group, according to the principle of non matching analysis and comparison, explore the related factors affecting the formation of gout in Guangxi rural areas. 1. Comparison between the gout group and the control group (1) the comparison of all kinds of food consumption in the case group and the control group: the average consumption of many kinds of food in the case group is higher than that of the control group, of which two groups are among the two groups The difference in consumption of meat, purine, low alcohol, beer, rice wine, high alcohol and total alcohol was statistically significant (P0.05). (2) compare the exposure rate of food and alcohol intake: according to the intake of all kinds of food in the survey and the recommended intake of Chinese residents' dietary guidelines in 2016, compare the intake of various kinds of food through single cause The results showed that there was a significant difference between the case group and the control group in the viscera, pork and purine intake (P0.05); rice wine, beer, low alcohol and total alcohol intake were also statistically significant (P0.05). (3) the logistics regression analysis of various models. The results were as follows: model 1 (age, occupation, educational level, family annual income, The family history of gout, BMI, meat, viscera as a model) showed an excessive intake of viscera and meats to increase the risk of gout. Model 2 (age, occupation, education, family income, family history of gout, BMI, meat, viscera, beer, rice wine as models) showed intakes of viscera, meat, beer and rice wine, and increased gout risk. The risk of gout suffering from gout was 4.5 times as high as that of 25g/d subjects. The risk of excessive intake of rice wine (converted into alcohol 25g/d) was 4 times more than that of rice wine; model 3 (age, occupation, education, family income, family history of pain wind, BMI, total purine, total alcohol intake as models) showed that the risk of excessive intake of gout was 4.5 times as high as that of the subjects. After converting all kinds of food into purine, the total purine intake was more than 1000mg/d, and the risk of gout increased by.2 when the total alcohol intake was 25g/d. The comparison between the gout group and the painless wind stone group (1) showed that the average intake of the main food and fish in the painless wind stone group was higher than that in the gout group, and the difference was statistically significant (P0 (.05) (2) the stratification of all kinds of food in accordance with the recommended intake of Chinese dietary guidelines 2016> and the actual intake of food, stratified the consumption of all kinds of food. The results of single factor analysis showed that the risk of gout in the group of main food consumption more than 250g/d and fruit consumption more than 100g/d could be reduced. (3) multiple factor Logistic regression The relationship between age, nationality, gout course, staple food and fruit intake and the risk of gout disease showed that the gouty stone could be increased in Zhuang, gout course more than 6 years and more than 9 years after correction of sex, occupation, smoking, family history of gout, blood uric acid level, vegetables, fruit, livestock, meat, egg, viscera and alcohol intake. Risk, diet intake more than 250g/d and group of fruit intake more than 100g/d could reduce the risk of gouty stones. Conclusion 1, the main factors associated with gout may be found: according to different model logistic regression results, the risk of gout in the study subjects with visceral intake more than 50g/d is 4.5 of the subjects for the intake of 25g/d. The risk of gout in rice wine (25g/d) was 4 times less than that of rice wine; the risk of gout was significantly increased by.2 when the purine intake was more than 1000mg/d, and the total alcohol intake was 25g/d. The main findings were related to the formation of gout formation: the risk of gout in the gout patients and the duration of gout disease For more than 6 years, the risk of gouty stones increased significantly, and the intake of main food intake of cereals was more than 250g/d (250~400g/d), and the fruit intake was more than 100g/d as a protective factor for the formation of gout in rural areas of Guangxi.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589.7

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