本文選題：農(nóng)村地區(qū) + 痛風��； 參考：《廣西醫(yī)科大學》2017年碩士論文

【摘要】：研究背景痛風是一種常見的慢性營養(yǎng)代謝性疾病,尤其是在中老年男性多見,在全世界都有發(fā)病,既往報道我國痛風患病率相對較低,然而,近年來隨著我國經(jīng)濟實力的日益加強,人民生活的不斷改善,痛風患病狀況較之以往發(fā)生了明顯的改變。2014年廣西大化某鄉(xiāng)鎮(zhèn)發(fā)現(xiàn)多名關節(jié)畸形患者,被媒體稱為“大化怪病”,醫(yī)療主管部門組織醫(yī)療專家完善相關檢查后,診斷這些都是痛風伴發(fā)痛風石引起的嚴重關節(jié)畸形的患者,可見痛風及痛風石對廣西農(nóng)村地區(qū)居民造成了一定的經(jīng)濟及健康負擔。研究目的(1)初步了解廣西農(nóng)村地區(qū)痛風患者患病的膳食相關影響因素,為廣西農(nóng)村地區(qū)的痛風預防提供膳食指導意見。(2)初步了解廣西農(nóng)村地區(qū)痛風患者罹患痛風石的膳食影響因素,為廣西農(nóng)村地區(qū)的痛風患者預防痛風石的發(fā)生提供膳食指導意見。研究方法采用病例-對照的研究方法,以廣西的三江(內(nèi)陸地區(qū))、大化(大石山區(qū))、合浦(沿海地區(qū))作為調查點,通過當?shù)蒯t(yī)院治療信息搜索痛風患者并與之電話聯(lián)系初步確定痛風組調查人員,按1:1匹配隨機抽取當?shù)嘏c痛風研究對象年齡相近(±4歲),性別相同,居住地相近的非痛風居民初步定為對照組人群,以上所有調查對象完成現(xiàn)場問卷、體檢后,最后通過獲得臨床主治醫(yī)師以上資格的�？漆t(yī)師按1977年美國痛風協(xié)會診斷標準,根據(jù)相關檢查結果確定病例組及對照組研究對象。按照食物頻率法調查痛風患者既往食物攝入情況。通過相互比較,探索影響廣西農(nóng)村地區(qū)痛風患病的相關因素。根據(jù)最后收集到的數(shù)據(jù),按是否有痛風石將所有痛風患者分成痛風石組和無痛風石組,按照非匹配的原則進行分析比較,探索影響廣西農(nóng)村地區(qū)痛風居民痛風石形成的相關因素。研究結果1、痛風組與對照組對比(1)病例組和對照組的各類食物消費量比較:病例組的多種食物平均消費量高于對照組,其中兩組間肉類、嘌呤、低度酒、啤酒、米酒、高度酒和總酒精的消費量的差異有統(tǒng)計學意義(p0.05)。(2)比較食物和酒類酒精攝入量暴露率:根據(jù)調查中各類食物的攝入情況及2016年中國居民膳食指南推薦攝入量,將各類食物攝入情況進行比較,經(jīng)過單因素分析,結果顯示:病例組和對照組在內(nèi)臟、豬肉、嘌呤攝入量差異有統(tǒng)計學意義(p0.05);米酒、啤酒、低度酒和總酒精攝入量差異也有統(tǒng)計學意義(p0.05)。(3)多種模型的logistics回歸分析。結果如下:模型1(納入年齡、職業(yè)、文化程度、家庭年收入、痛風家族史、bmi、肉類、內(nèi)臟作為模型)顯示過量攝入內(nèi)臟和肉類增加痛風的風險;模型2(納入年齡、職業(yè)、文化程度、家庭年收入、痛風家族史、bmi、肉類、內(nèi)臟、啤酒、米酒作為模型)顯示攝入內(nèi)臟、肉類、啤酒和米酒過量,痛風的危險度增加,其中內(nèi)臟攝入量≥50g/d的研究對象其患痛風的風險是攝入量25g/d研究對象的4.5倍,米酒過量攝入(換算成酒精25g/d)患病風險是不喝米酒的4.0倍;模型3(納入年齡、職業(yè)、文化程度、家庭年收入、痛風家族史、bmi、總嘌呤、總酒精攝入量作為模型)顯示,各類食物換算成嘌呤后,總嘌呤攝入量≥1000mg/d,酒精總攝入量25g/d時罹患痛風的風險明顯增加。2、痛風石組與無痛風石組對比(1)各類食物消費情況比較顯示無痛風石組的主食和魚類平均攝入量均高于痛風石組,差異具有統(tǒng)計學意義(P0.05)。(2)各類食物分層比較按照《中國居民膳食指南2016》推薦攝入量并結合食物實際攝入情況,對各類食物消費量進行分層,單因素分析結果顯示主食消費量≥250g/d組和水果消費量≥100g/d組均可降低患痛風石的風險。(3)多因素logistic回歸分析年齡、民族、痛風病程、主食和水果攝入量與痛風石患病風險的關系顯示,在校正了性別、職業(yè)、吸煙、痛風家族史、血尿酸水平、蔬菜、水果、畜禽肉類、蛋類、內(nèi)臟和酒精攝入量等因素后,壯族、痛風病程≥6年和≥9年均可增加痛風石的患病風險;主食攝入量≥250g/d組和水果攝入量≥100g/d組均可降低痛風石的患病風險。結論1、主要發(fā)現(xiàn)可能的痛風發(fā)病相關因素:根據(jù)不同的模型logistic回歸結果顯示,內(nèi)臟攝入量≥50g/d的研究對象罹患痛風的風險是攝入量25g/d研究對象的4.5倍;米酒攝入過量(25g/d)罹患痛風的風險是不喝米酒的4.0倍;嘌呤攝入量≥1000mg/d及酒精總攝入量25g/d時罹患痛風的風險明顯增加。2、主要發(fā)現(xiàn)可能與痛風石形成有關的因素:本研究發(fā)現(xiàn)痛風患者痛風石的患病風險與痛風患病的病程長短有關,病程大于6年以上患者其罹患痛風石的風險顯著增加;谷薯類主食攝入量≥250g/d(推薦攝入量250~400g/d)、水果攝入量≥100g/d為廣西農(nóng)村地區(qū)居民痛風石形成的保護性因素。
[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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R589.7

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