以病例對照研究法探討血漿中金屬元素與男性痛風的相關性

The Relation between Metals Concentration in Plasma and Male Gout: A Case-Control Study

莊冠群(Kuan-Chun Chuang)

指導教授 ： 葉錦瑩 博士

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2002年)

摘要

摘要 痛風是由於尿酸沉積在關節附近後伴隨發炎的一種臨床症狀，一般認為是因為尿酸的過度製造或排泄不良，導致血中尿酸濃度過高的現象。痛風常發生於高齡人口，近年來由於飲食型態的改變及慢性疾病的增加而導致發生年齡層有下降的趨勢。痛風常侵襲多處關節，通常與利尿劑的使用、高血壓以及腎臟方面的疾病或損傷均有關係。痛風好發於男性，偶發於停經婦女，但鮮少發生於經期婦女中，推測可能與鐵質的累積有關係，而高量的鐵蛋白與飽和輸鐵蛋白以及低量的銅鋅超氧化歧與銅硫新質等，均可能與尿酸鈉鐵結晶鹽的沉積進而影響痛風的發生有關。因此，本研究除利用問卷分析來了解病例組與對照組之間的危險因子外，並測定血漿中鐵、鋅及銅元素含量以探討三種金屬與痛風之關係。 本研究隨機選取了台北市立和平醫院痛風門診的病患76人為病例組，並以病人的同事與朋友共82位為對照組。以問卷收集其社會人口學資料及各種營養素24小時攝取量，並收集其血液檢體以石墨式原子吸收光譜儀 (Graphic Furnace Automatic Absorption Spectrum；SpectrAA 220Z) 偵測血漿中銅（Cu）、鋅（Zn）與鐵（Fe）元素含量。根據問卷分析發現，病例組與對照組間達到統計上顯著性差異的社會人口學變項有身體質量指數、教育程度、收縮壓、腰圍、家族痛風史及家族糖尿病史等。二十四小時飲食問卷資料，以羅吉斯迴歸分析後，發現鐵元素攝取量在兩組之間有顯著性差異 (p = 0.0075)，而維他命B2、葉酸、維他命A、總膳食纖維等營養素之攝取對痛風有保護作用。至於血漿中金屬元素含量分析結果，只有鋅（p = 0.03）在兩組有顯著性差異，鐵（p = 0.43）以及銅（p = 0.24）則無統計上差異。再以羅吉斯複迴歸模式調整年齡、身體質量指數、教育程度、葉酸、膳食纖維、家族痛風史與家族糖尿病史後發現血漿中鐵含量偏高，銅含量偏低或鋅含量偏高者，其罹患痛風的危險性較高，其趨勢呈統計上的顯著性。 關鍵字：痛風、鋅、銅、鐵

關鍵字

痛風 ； 鋅 ； 銅 ； 鐵

並列摘要

Abstract Gout is a clinical syndrome resulting from deposition of monosodium urate crystals in and around joints, with the subsequent development of a variable inflammatory response. And it has been recognized as a disorder of altered uric acid metabolism, either over production or under excretion of uric acid, resulting in high blood uric acid concentration. Gout presents significantly in the elderly, but eating pattern change and chronic disease increasing result in the decrease of the onset age. Gout attacks are frequently polyarticular and it may be associated with diuretic use, hypertension and renal impairment. Because gout affects male mostly and postmenopausal women occasionally, but menstruating women seldom, the pattern of iron accumulation should be concerned. Precipitation of sodium urate-iron crystals in the joints may due to high ferritin and saturated transferrin and low CuZn-SOD and Cu-thionein in the joint. Therefore, the objective of this study is to explore the relation between iron, zinc and copper levels in plasma and male gout. A total of 76 patients with gout was randomly sampled from out-patient clinics in Taipei Municipal Ho-Ping Hospital. A sample of 82 controls was sampled from patients' friends or colleague. The social demographic and nutrition intake data were collected by questionnaire. The blood samples were also collected and detected for iron, zinc and copper level in plasma by the automatic absorption spectrum (AAS). According to the data of questionnaire, BMI, education, systolic blood pressure and waist, family history with gout and family history with diabetes were the risk factors of gout. After analysis by the logistic regression, we found that Fe intake was significantly different (p = 0.0075) in the cases and controls. Intakes of vitaminB2, folic acid, vitamin A and total dietary fiber in the 24hours recall questionnaires had prevention effect for gout. Only zinc in the plasma was significantly different (p = 0.03) in cases and controls, but Fe (p = 0.43) and copper (p = 0.24) were not. After adjusted by age, education, history of family with diabetes, history of family with gout, BMI, folic acid and total energy intake, it was showed that the higher Fe concentration, the lower copper concentration and the higher zinc concentration in plasma was, the higher risk in gout was found. Key wards：Gout Zinc Copper Fe

並列關鍵字

gout ； zinc ； copper ； fe

參考文獻

參考文獻 Ahmed, M., Taylor, W., Smith, P.R. and Becker, M.A. (1999). Accelerated transcription of PRPS1 in X-linked overactivity of normal human phosphoribosylpyrophosphate synthetase. The Journal of Biological Chemistry 274: 7482-7488.

Bajpayee, D.P. (1975) Significance of plasma copper and caeruloplasmin concentrations in rheumatoid arthritis. Annals of the Rheumatic Diseases. 34: 162-165.

Becker, M.A., Heidler, S.A., Bell, G.I., Seino, S., Le Beau, M.M., Westbrook, C.A., Neuman, W., Shapiro, L.J., Mohandas, T.K., Roessler, B.J. and Palella, T.D. (1990). Cloning of cDNA for human phosphoribosylpyrophosphate synthetases 1 and 2 X chromosome localization of PRPS1 and PRPS2 genes. Genomics 8: 555-561.

Becker, M.A., Smith, P.R., Taylor, W., Mustafi, R. and Switzer, R.L. (1995) The genetic and functional basis of purine nucleotide feedback-resistant phosphoribosylpyrophosphate synthetase super activity. The Journal of Clinical Investigation 96: 2133-2141.

Cassim, B., Mody, G.M., Deenadayalu, V.K. and Hammond, M.G. (1994) Gout in black South Africans: a clinical and genetic study. Annals of the Rheumatic Diseases 53: 759-762.