[ 摘要 ]
本研究為了探討台灣原住民痛風復發情形及其相關因子，選取原住民布農族與泰雅族二族作為研究族群，研究設計為matched cross-section study，以性別、族別與年齡(±3歲)配對痛風者和對照者，於民國91年10月至92年5月共收集260名個案，痛風者有110人而對照者有150人，利用SAS 8.2版統計軟體分析所收集的資料包括人口學資料、生化檢查值與酒精代謝基因乙醇去氫酶2 (alcohol dehydrogenase 2 ；ADH2)、乙醇去氫酶3 (alcohol dehydrogenase 3；ADH3 )和乙醛去氫酶2 (aldehyde dehydrogenase 2；ALDH2)之基因多型性。
經初步分析及逐步邏輯回歸校正分析後，得知痛風主要預測因子有：1.高血壓、 2.肌氨酸酐、 3.尿酸及 4.乙醛去氫酶2*2(ALDH2*2)。結果顯示有高血壓比沒高血壓發生痛風的危險性約4.8 倍；肌氨酸酐>=1.5 mg/dl 比<1.5 mg/dl 發生痛風的危險性達 13 倍；高尿酸血症(血清尿酸值男性>=7 mg/dl 或女性>=6 mg/dl )時發生痛風的危險性約 4.1 倍；乙醛去氫酶2 帶有*2 Allele 比帶有*1 Allele發生痛風的危險性達 26 倍。
結果發現最近一年內痛風有復發佔96%，最近一個月內痛風有復發佔71%，初步分析痛風復發的相關因子包括：1.種族、2.年齡、
3.總飲酒精量(in log)、4.痛風石和 5.ALDH2*1，再經逐步邏輯回歸校正分析後，痛風復發主要預測因子為ALDH2*1，顯示痛風患者乙醛去氫酶2 帶有*1 Allele比帶有*2 Allele 痛風復發的危險性達 12 倍。
因此，原住民痛風相關因子除高血壓、尿酸與肌氨酸酐外，酒精代謝基因乙醛去氫酶2帶有*2 Allele也是痛風的危險因子；但在原住民痛風復發上，乙醛去氫酶2帶有*2 Allele 反而是一保護因子。
[ 英文摘要 ]
Abstract
This study investigated gout recurrence and associated factors of gout recurrence in Taiwan aborigines. There are two aboriginal tribes (Atayal, Bunun) included as the study population. We collected 110 cases of gout and 150 controls of sex- , tribe- and age-matched in the cross section study. We analyzed the relationships between social demographic data, whole blood biochemical examination, alcohol dehydrogenase 2, alcohol dehydrogenase 3, and aldehyde dehydrogenase 2 polymorphisms and gout recurrence.
After the stepwise logistic regression model adjusted the confounders , the results showed that the following factors were significantly in statistics related to gout:
1. hypertension (Odds Ratio=4.8，95%CI=1.4-15.7) , 2. creatinie>=1.5mg/dl (Odds Ratio=13，95%CI=1.2-145), 3. hyperuricemia (Odds Ratio=4.1，95%CI=1.2-14.2), 4. ALDH2*2 (Odds Ratio=26，95%CI=4.2-167).
The results showed the gout recurrence rate in recent a year was 96%, and the gout recurrence rate in recent a month was 71%. After the preliminary analysis that factors related to gout recurrence included 1. tribe (Odds ratio=3.2，95%CI=1.4-7.7), 2. age>=40 years old (Odds ratio=2.8，95%CI=1.2-6.7), 3. tatol alcohol amount in log (Odds ratio=4.1，95%CI=1.0-16.3), 4. tophus(Odds ratio=3.4，95%CI=1.1-10.3), 5. ALDH2*non2 (Odds ratio=2.6，95%CI=1.02-7.0). After the stepwise logistic regression model adjusted the confounders, only showed that only ALDH2*non2 (Odds ratio=12.2，95%CI=1.2-117.4) was a associated factor of gout recurrence.
This study concluded that the associated factors of gout in Taiwan aborigines included hypertension, creatinie, hyperuricemia and ALDH2*2. On the other hand, ALDH2*2 was a protect factor of the association of gout recurrence in Taiwan aborigines.