原发性痛风患者发生骨质疏松症的危险因素分析及预测模型构建

doi:10.3969/j.issn.1004-583X.2026.04.006

摘要/Abstract

摘要：

目的分析男性原发性痛风患者合并骨质疏松症的临床特点及独立危险因素,构建适用于该人群的骨质疏松风险预测工具,为早期临床筛查提供参考。方法采用回顾性队列设计,共纳入西充县人民医院和川北医学院附属医院就诊的348例男性原发性痛风患者。采集所有对象的临床资料、实验室指标与骨密度结果。将单因素分析中P<0.05的变量纳入多因素logistic回归模型,建立预测公式。采用受试者工作特征曲线评估模型区分能力,Bootstrap重抽样法进行内部验证,Hosmer-Lemeshow检验及校准曲线评估校准度。结果 348例男性患者中,骨质疏松症31例(8.9%)。单因素分析显示年龄、病程、痛风石、糖尿病、超敏C反应蛋白及血肌酐与骨质疏松显著相关(P<0.05)。多因素logistic回归确立年龄、痛风石和血肌酐为独立危险因素。预测模型:Logit(P)=-6.425+0.055×年龄(岁)+1.038×痛风石(有=1,无=0)+0.005×血肌酐(μmol/L)。模型初始AUC为0.796,Bootstrap校正后AUC为0.781,Hosmer-Lemeshow检验P=0.422,校准曲线显示拟合良好。结论高龄、合并痛风石及血肌酐升高是男性原发性痛风患者发生骨质疏松症的独立危险因素。构建的风险预测模型具有良好的区分能力与校准度,可作为筛查中老年男性痛风患者骨质疏松高危人群的有效工具。

关键词: 痛风, 骨质疏松症, 危险因素, 预测模型

Abstract:

Objective To analyze the clinical characteristics and independent risk factors of osteoporosis in male patients with primary gout, and to develop an osteoporosis risk prediction tool for this population to support early clinical screening. Methods A retrospective cohort design was used, involving 348 male patients with primary gout at Xichong County People's Hospital and Affiliated Hospital of North Sichuan Medical College. Clinical data, laboratory indices, and bone mineral density results were collected for all participants. Variables with P<0.05 in the univariate analysis were entered into a multivariate logistic regression model to establish a prediction formula. Receiver operating characteristic curve analysis was used to evaluate the discriminative ability of the model. Bootstrap resampling was performed for internal validation, and the Hosmer-Lemeshow test and calibration curve were used to assess calibration. Results Among the 348 male patients, 31 cases (8.9%) had osteoporosis. Univariate analysis showed that age, disease duration, tophi, diabetes, high-sensitivity C-reactive protein, and serum creatinine were significantly associated with osteoporosis (P<0.05). Multivariate logistic regression identified age, tophi, and serum creatinine as independent risk factors. The prediction model was as follows: Logit(P)=-6.425+0.055×age (years)+1.038×tophi (yes=1, no=0)+0.005×serum creatinine (μmol/L). The initial area under the curve (AUC) of the model was 0.796, and the Bootstrap-corrected AUC was 0.781. The Hosmer-Lemeshow test yielded P=0.422, and the calibration curve indicated good model fit. Conclusion Advanced age, presence of tophi, and elevated serum creatinine are independent risk factors for osteoporosis in male patients with primary gout. The constructed risk prediction model demonstrates good discriminative ability and calibration, and may serve as an effective tool for screening high-risk osteoporosis in middle-aged and elderly male patients with gout.

Key words: gout, osteoporosis, risk factors, prediction model

中图分类号:

R589.7
R681

王鹏, 余玲, 胥力川, 庞敏, 李果, 郑洪锟, 张全波, 青玉凤. 原发性痛风患者发生骨质疏松症的危险因素分析及预测模型构建[J]. 临床荟萃, 2026, 41(4): 323-327.

Wang Peng, Yu Ling, Xu Lichuan, Pang Min, Li Guo, Zheng Hongkun, Zhang Quanbo, Qing Yufeng. Risk factors for osteoporosis in patients with primary gout and development of a prediction model[J]. Clinical Focus, 2026, 41(4): 323-327.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.04.006

https://www.lchc.cn/CN/Y2026/V41/I4/323

图/表 3

表1 原发性痛风患者中骨质疏松组与非骨质疏松组的基线资料对比

Tab.1 Baseline characteristics of patients with primary gout in the osteoporosis and non-osteoporosis groups

变量	总体( $n$ =348)	骨质疏松组( $n$ =31)	非骨质疏松组( $n$ =317)	统计值	$P$ 值
人口学特征
年龄(岁)	57.3±15.2	68.9±12.1	56.1±15.0	$t$ =4.98	<0.001
体重指数(kg/m²)	25.3±4.3	24.7±4.2	25.4±4.3	$t$ =0.85	0.396
痛风相关特征
病程(年)	7.0(3.0, 11.0)	10.0(5.0, 18.0)	7.0(2.5, 10.0)	$Z$ =2.31	0.021
痛风石[例(%)]	70(20.1)	13(41.9)	57(18.0)	χ²=10.24	0.001
生活习惯[例(%)]
吸烟史	149(42.8)	11(35.5)	138(43.5)	χ²=0.74	0.390
饮酒史	186(53.4)	18(58.1)	168(53.0)	χ²=0.30	0.584
合并症[例(%)]
高血压	122(35.1)	13(41.9)	109(34.4)	χ²=0.73	0.393
糖尿病	33(9.5)	6(19.4)	27(8.5)	χ²=3.98	0.046
肾结石	21(6.0)	3(9.7)	18(5.7)	χ²=0.82	0.365
实验室指标
hs-CRP(mg/L)	53.0(23.0, 69.0)	81.0(46.0, 126.0)	51.0(21.0, 64.0)	$Z$ =2.92	0.003
白细胞(×10⁹/L)	8.4±3.2	9.1±3.8	8.3±3.1	$t$ =1.42	0.156
丙氨酸氨基转移酶(U/L)	28.0(18.0, 42.0)	26.0(17.0, 39.0)	28.0(18.0, 43.0)	$Z$ =0.55	0.582
天门冬氨酸氨基转移酶(U/L)	24.0(18.0, 33.0)	25.0(19.0, 35.0)	24.0(18.0, 32.0)	$Z$ =0.68	0.497
白蛋白(g/L)	39.8±5.2	38.6±5.8	39.9±5.1	$t$ =1.31	0.190
血尿酸(μmol/L)	488.5±143.0	516.0±154.0	485.0±141.0	$t$ =1.06	0.290
血肌酐(μmol/L)	98.2(71.0, 114.5)	136.0(96.0, 187.0)	95.0(69.0, 109.0)	$Z$ =3.18	0.001
甘油三酯(mmol/L)	1.45(0.96, 2.10)	1.60(1.05, 2.45)	1.44(0.95, 2.08)	$Z$ =1.15	0.250
总胆固醇(mmol/L)	4.41±1.18	4.28±1.05	4.42±1.19	$t$ =0.63	0.528
低密度脂蛋白胆固醇(mmol/L)	2.65±0.98	2.58±0.87	2.66±0.99	$t$ =0.44	0.664
血糖(mmol/L)	5.6(5.0, 6.5)	6.2(5.3, 7.8)	5.5(5.0, 6.4)	$Z$ =1.98	0.048

表1 原发性痛风患者中骨质疏松组与非骨质疏松组的基线资料对比

Tab.1 Baseline characteristics of patients with primary gout in the osteoporosis and non-osteoporosis groups

变量	总体( $n$ =348)	骨质疏松组( $n$ =31)	非骨质疏松组( $n$ =317)	统计值	$P$ 值
人口学特征
年龄(岁)	57.3±15.2	68.9±12.1	56.1±15.0	$t$ =4.98	<0.001
体重指数(kg/m²)	25.3±4.3	24.7±4.2	25.4±4.3	$t$ =0.85	0.396
痛风相关特征
病程(年)	7.0(3.0, 11.0)	10.0(5.0, 18.0)	7.0(2.5, 10.0)	$Z$ =2.31	0.021
痛风石[例(%)]	70(20.1)	13(41.9)	57(18.0)	χ²=10.24	0.001
生活习惯[例(%)]
吸烟史	149(42.8)	11(35.5)	138(43.5)	χ²=0.74	0.390
饮酒史	186(53.4)	18(58.1)	168(53.0)	χ²=0.30	0.584
合并症[例(%)]
高血压	122(35.1)	13(41.9)	109(34.4)	χ²=0.73	0.393
糖尿病	33(9.5)	6(19.4)	27(8.5)	χ²=3.98	0.046
肾结石	21(6.0)	3(9.7)	18(5.7)	χ²=0.82	0.365
实验室指标
hs-CRP(mg/L)	53.0(23.0, 69.0)	81.0(46.0, 126.0)	51.0(21.0, 64.0)	$Z$ =2.92	0.003
白细胞(×10⁹/L)	8.4±3.2	9.1±3.8	8.3±3.1	$t$ =1.42	0.156
丙氨酸氨基转移酶(U/L)	28.0(18.0, 42.0)	26.0(17.0, 39.0)	28.0(18.0, 43.0)	$Z$ =0.55	0.582
天门冬氨酸氨基转移酶(U/L)	24.0(18.0, 33.0)	25.0(19.0, 35.0)	24.0(18.0, 32.0)	$Z$ =0.68	0.497
白蛋白(g/L)	39.8±5.2	38.6±5.8	39.9±5.1	$t$ =1.31	0.190
血尿酸(μmol/L)	488.5±143.0	516.0±154.0	485.0±141.0	$t$ =1.06	0.290
血肌酐(μmol/L)	98.2(71.0, 114.5)	136.0(96.0, 187.0)	95.0(69.0, 109.0)	$Z$ =3.18	0.001
甘油三酯(mmol/L)	1.45(0.96, 2.10)	1.60(1.05, 2.45)	1.44(0.95, 2.08)	$Z$ =1.15	0.250
总胆固醇(mmol/L)	4.41±1.18	4.28±1.05	4.42±1.19	$t$ =0.63	0.528
低密度脂蛋白胆固醇(mmol/L)	2.65±0.98	2.58±0.87	2.66±0.99	$t$ =0.44	0.664
血糖(mmol/L)	5.6(5.0, 6.5)	6.2(5.3, 7.8)	5.5(5.0, 6.4)	$Z$ =1.98	0.048

表2 骨质疏松症影响因素的单因素logistic回归分析

Tab.2 Univariate logistic regression analysis of factors influencing osteoporosis

变量	回归系数	标准误	Wald χ²值	$O R$ 值	95% $C I$	$P$ 值
年龄(岁)	0.056	0.014	16.00	1.058	1.031-1.086	<0.01
病程(年)	0.048	0.018	7.11	1.049	1.013-1.086	0.008
痛风石(有vs无)	1.165	0.398	8.57	3.205	1.472-6.979	0.003
糖尿病(有vs无)	0.972	0.435	4.99	2.643	1.127-6.202	0.026
血肌酐(μmol/L)	0.006	0.002	9.00	1.006	1.002-1.010	0.003
hs-CRP(mg/L)	0.007	0.003	5.44	1.007	1.001-1.013	0.020
体重指数(kg/m²)	-0.024	0.036	0.44	0.976	0.908-1.049	0.507
吸烟史(有vs无)	-0.090	0.378	0.06	0.914	0.436-1.917	0.812
饮酒史(有vs无)	0.150	0.373	0.16	1.162	0.558-2.421	0.689
高血压(有vs无)	0.192	0.371	0.27	1.212	0.582-2.524	0.608
肾结石(有vs无)	0.520	0.538	0.93	1.682	0.582-4.860	0.334
血尿酸(μmol/L)	0.001	0.001	1.14	1.001	0.999-1.003	0.285
血糖(mmol/L)	0.062	0.041	2.29	1.064	0.983-1.152	0.130

表2 骨质疏松症影响因素的单因素logistic回归分析

Tab.2 Univariate logistic regression analysis of factors influencing osteoporosis

变量	回归系数	标准误	Wald χ²值	$O R$ 值	95% $C I$	$P$ 值
年龄(岁)	0.056	0.014	16.00	1.058	1.031-1.086	<0.01
病程(年)	0.048	0.018	7.11	1.049	1.013-1.086	0.008
痛风石(有vs无)	1.165	0.398	8.57	3.205	1.472-6.979	0.003
糖尿病(有vs无)	0.972	0.435	4.99	2.643	1.127-6.202	0.026
血肌酐(μmol/L)	0.006	0.002	9.00	1.006	1.002-1.010	0.003
hs-CRP(mg/L)	0.007	0.003	5.44	1.007	1.001-1.013	0.020
体重指数(kg/m²)	-0.024	0.036	0.44	0.976	0.908-1.049	0.507
吸烟史(有vs无)	-0.090	0.378	0.06	0.914	0.436-1.917	0.812
饮酒史(有vs无)	0.150	0.373	0.16	1.162	0.558-2.421	0.689
高血压(有vs无)	0.192	0.371	0.27	1.212	0.582-2.524	0.608
肾结石(有vs无)	0.520	0.538	0.93	1.682	0.582-4.860	0.334
血尿酸(μmol/L)	0.001	0.001	1.14	1.001	0.999-1.003	0.285
血糖(mmol/L)	0.062	0.041	2.29	1.064	0.983-1.152	0.130

表3 骨质疏松影响因素的多因素logistic回归分析

Tab.3 Multivariate logistic regression analysis of factors influencing osteoporosis

变量	回归系数	标准误	Wald χ²值	$O R$ 值	95% $C I$	$P$ 值
常数项	-6.425	1.402	20.99	0.002	0.000-0.015	<0.01
年龄(岁)	0.055	0.015	13.44	1.057	1.027-1.088	<0.01
病程(年)	0.028	0.019	2.17	1.028	0.991-1.067	0.141
痛风石(有vs无)	1.038	0.425	5.97	2.824	1.228-6.493	0.015
糖尿病(有vs无)	0.839	0.451	3.46	2.315	0.956-5.605	0.063
血肌酐(μmol/L)	0.005	0.002	6.25	1.005	1.001-1.009	0.012
超敏C反应蛋白(mg/L)	0.004	0.003	1.78	1.004	0.998-1.010	0.182

表3 骨质疏松影响因素的多因素logistic回归分析

Tab.3 Multivariate logistic regression analysis of factors influencing osteoporosis

变量	回归系数	标准误	Wald χ²值	$O R$ 值	95% $C I$	$P$ 值
常数项	-6.425	1.402	20.99	0.002	0.000-0.015	<0.01
年龄(岁)	0.055	0.015	13.44	1.057	1.027-1.088	<0.01
病程(年)	0.028	0.019	2.17	1.028	0.991-1.067	0.141
痛风石(有vs无)	1.038	0.425	5.97	2.824	1.228-6.493	0.015
糖尿病(有vs无)	0.839	0.451	3.46	2.315	0.956-5.605	0.063
血肌酐(μmol/L)	0.005	0.002	6.25	1.005	1.001-1.009	0.012
超敏C反应蛋白(mg/L)	0.004	0.003	1.78	1.004	0.998-1.010	0.182

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