痛风急性发作的护理

目的：分析总结痛风急性发作的护理措施。方法：对自2010年3月～2013年11月我院收治的51例痛风急性发作期患者实施了有针对性护理。结果：经秋水仙碱等药物的治疗以及有针对性的护理,51例患者症状均明显缓解,尿酸不同程度的降低。结论：有针对性的护理措施对于患者病情的缓解有重要作用。     

Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis

Septic arthritis and gout are major diseases that should be suspected in patients with acute monoarthritis. These two diseases are clinically similar and often indistinguishable without the help of synovial fluid analysis. Recently, a novel diagnostic rule for gout without synovial fluid analysis was developed and showed relevant performances. This study aimed to determine whether this diagnostic rule could perform well in distinguishing gout from septic arthritis. The diagnostic rule comprises 7 clinical and laboratory variables, each of which is given a specified score. The probability of gout is classified into 3 groups according to the sum of the scores: high (≥ 8), intermediate (> 4 to < 8) and low probability (≤ 4). In this retrospective study, we applied this diagnostic rule to 136 patients who presented as acute monoarthritis and were subsequently diagnosed as acute gout (n = 82) and septic arthritis (n = 54) based on synovial fluid analysis. The mean sum of scores of acute gout patients was significantly higher than that of those with septic arthritis (8.6 ± 0.2 vs. 3.6 ± 0.32, P < 0.001). Patients with acute gout had significantly more ''high'', and less ''low'' probabilities compared to those with septic arthritis (Eta[η]: 0.776). The prevalence of acute gouty arthritis, as confirmed by the presence of monosodium crystal, was 95.5% (61/64), 57.5% (19/33), and 5.1% (2/39) in high, intermediate and low probability group, respectively. The recently introduced diagnostic rule properly discriminates acute gout from septic arthritis. It may help physicians diagnose gout in cases difficult to be differentiated from septic arthritis.

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一个原发性痛风家系致病易感基因染色体定位

目的 对一原发性痛风家系进行致病基因的染色体定位。方法 收集痛风家系成员的临床资料及血液样本。选择其中一典型家系为研究对象（包括6例患者，9例正常人），抽提外周血基因组DNA，进行全基因组扫描和连锁分析，初步明确致病基因所在的染色体区段。结果 在微卫星引物D4S1572处获得最大LOD值（θ=0．00时LOD=1．50），表明该痛风家系的致病基因与该位点连锁。结论 由于D4S1572位于4q25，因此该家系致病基因位于4q25附近。     

痛风性关节炎的CT、MRI对照分析

目的比较CT、MRI影像检查在痛风性关节炎中的诊断价值。方法选取我院2017年4月~2020年4月收治的经临床证实为痛风性关节炎患者80例作为观察对象,对所有患者实施CT及MRI检查,观察两种检查方法的诊断结果及影像学表现。结果80例患者确诊病变关节194个。CT检查共检出病变关节146个,MRI共检出病变关节186个,CT检查灵敏度(146/194)低于MRI(173/194)(P<0.05);相比于CT,MRI在关节积液、痛风结节、滑膜增厚、骨质破坏、关节周围水肿的检出率都更高。结论MRI对痛风性关节炎的诊断效果良好,可对关节炎病变进行较为准确的观察,具有临床推广价值。     

A meta-analysis of the associations between the Q141K and Q126X ABCG2 gene variants and gout risk

Background: Gout is an inflammatory disease in which genetic factors play a role. ABCG2 is a urate transporter, and the Q141K and Q126X variants of ABCG2 have been associated with a risk of developing gout, though previous studies of these associations have been inconsistent. Therefore, we conducted a meta-analysis to explore the relationship between these genetic variants and gout. Methods: We examined 8 electronic literature databases. In total, 9 eligible articles on the associations between the Q141K (rs2231142) and Q126X (rs72552713) variants and gout risk, including 11 case-control studies were selected. We used odds ratios (OR) and 95% confidence intervals (CI) to assess the strength of these relationships in dominant, recessive, and co-dominant models. Results: This study included 6652 participants (2499 gout patients and 4153 controls). The Q141K variant was found to significantly increase the risk of gout in Asians (dominant model: OR=2.64, 95% CI=2.04-3.43, P=0.02 for heterogeneity; recessive model: OR=3.19, 95% CI=2.56-3.97, P=0.28 for heterogeneity; co-dominant model: OR=1.37, 95% CI=1.18-1.59, P=0.09 for heterogeneity) and other populations (dominant model: OR=1.85, 95% CI=1.20-2.85, P<0.0001 for heterogeneity; recessive model: OR=3.78, 95% CI=2.28-6.27, P=0.19 for heterogeneity; co-dominant model: OR=1.48, 95% CI=1.26-1.74, P=0.19 for heterogeneity). The Q126X variant also significantly increased the risk of gout in Asians (dominant model: OR=3.87, 95% CI=2.07-7.24, P=0.06 for heterogeneity). Conclusions: These results suggest associations between the rs2231142 and rs72552713 ABCG2 gene polymorphisms and gout risk, which led to unfavorable outcomes. However, studies with larger sample sizes and homogeneous populations should be performed to confirm these results.     

高尿酸血症及痛风性关节炎动物模型及其中药复方治疗概况

痛风是嘌呤代谢紊乱和/或尿酸排泄减少而致血尿酸水平升高,尿酸盐(monosodium urate,MSU)晶体沉积于组织或器官并引起组织损伤的一组临床综合征,主要表现为反复发作性关节红、肿、热、痛与功能障碍,甚至关节畸形、肾石病及尿酸性肾病。高尿酸血症是痛风发生的生化基础。流行病学显示痛风的发病率在世界范围内呈逐年上升趋势。高尿酸血症/痛风严重危害人类健康,对于其发生发展机制的研究以及相关药物治疗的研究越来越受到科研工作者的重视。因此,对于高尿酸血症、痛风性关节炎动物模型的研究以及中药复方制剂在高尿酸血症/痛风中疗效的研究正如雨后春笋般如火如荼,它将从高尿酸血症、痛风性关节炎动物模型的研究及中药复方制剂在高尿酸血症/痛风中疗效的研究现状及概况做一综述。     

中国山东沿海地区汉族男性人群白介素-23受体基因多态性与痛风的易感性研究

目的探讨中国山东省沿海地区汉族男性群体的白细胞介素23受体（IL-23R）基因rs7517847位点G／T的多态性是否与痛风的易感性有关。方法选取202例痛风患者和346例健康对照者,检测中国汉族男性群体的IL-23受体内含子区rs7517847位点基因多态性分布,数据经,检验得出其与痛风发病的遗传易感性的关系。结果经,检验,痛风组和对照组中IL-23R基因rs7517847位点GG,GT和1Tr基因型频率（10．4％,49．5％,40．1％;16．2％,49．7％,34．1％;X^2=4．305,P〉0．05）与等位基因频率G和T（35．1％,41％;64．9％,59％;X^2=3．727,P〉0．05）均无统计学意义。IL-23R基因rs7517847位点G／T基因多态性与痛风病的危险因素无显著性关联。结论尚不能认为中国沿海地区汉族男性人群中IL-23R内含子区rs7517847位点基因多态性与痛风有关联性。     

Prevention of Comorbidity and Acute Attack of Gout by Uric Acid Lowering Therapy

The object of this study was to evaluate the effect of uric acid lowering therapy in reducing the new development of comorbidities and the frequency of acute attacks in gout patients. We retrospectively reviewed patients who were diagnosed to have gout with at least 3 yr of follow up. They were divided into 2 groups; 53 patients with mean serum uric acid level (sUA)<6 mg/dL and 147 patients with mean sUA≥6 mg/dL. Comorbidities of gout such as hypertension (HTN), type II diabetes mellitus (DM), chronic kidney disease, cardiovascular disease (CVD) and urolithiasis were compared in each group at baseline and at last follow-up visit. Frequency of acute gout attacks were also compared between the groups. During the mean follow up period of 7.6 yr, the yearly rate of acute attack and the new development of HTN, DM, CVD and urolithiasis was lower in the adequately treated group compared to the inadequately treated group. Tight control of uric acid decreases the incidence of acute gout attacks and comorbidities of gout such as HTN, DM, CVD and urolithiasis.

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葡萄糖转运体9基因 rs3733591（C>T）的单核苷酸多态性与我国汉族人群原发性痛风发病的相关性研究

目的探讨葡萄糖转运体9（SLC2A9）基因 rs3733591（C>T）的单核苷酸多态性（SNPs）与我国汉族人群痛风发病及血尿酸水平的相关性,并分析其多态性与痛风患者、健康体检者 PBMCs SLC2A9 mRNA 表达的相关性。方法①采用 TaqMan?探针法检测痛风组（297例原发性痛风性关节炎患者）和健康对照组（211名健康体检者） rs3733591（C>T）位点的基因型,χ2检验比较2组基因型及等位基因分布频率,计算比值比（OR）及95%可信区间（95%CI）。②采用实时荧光定量-PCR（RT-qPCR）法检测46例间歇期痛风患者及40名健康对照组 PBMCs SLC2A9 mRNA 的表达水平,非参数检验比较各组变量间的差异,并分析与 rs3733591（C>T）多态性的相关性。结果 rs3733591（C>T）位点的 TT 基因型在痛风组的分布频率显著低于健康对照组（37.7%与48.3%,P=0.017）,携带 TT 基因型的个体罹患痛风的相对风险OR 为0.647（95%CI：0.452~0.925）。而等位基因 T 在痛风组中的分布频率为60.9%,显著低于健康对照组的69.2%（χ2=7.324,P=0.007）,携带等位基因 T 的个体罹患痛风的相对风险 OR 为0.695（95%CI：0.533~0.905）;等位基因 C 在痛风组中的分布频率为39.1%,显著高于健康对照组的30.8%（χ2=1.440,P<0.05）。痛风组中携带 TC 基因型个体的外周血单个核细胞 SLC2A9 mRNA 的表达水平显著高于携带 TT 基因型者,而痛风组及健康对照组携带其他基因型的个体 SLC2A9 mRNA 的表达差异无统计学意义（P>0.05）。有痛风石（30例）痛风患者与无痛风石（190例）痛风患者的基因型及等位基因分布频率差异无统计学意义（P>0.05）。结论本研究提示 SLC2A9基因 rs3733591（C>T）位点的多态性可能与我国汉族人群原发性痛风的易感性相关,而与痛风患者痛风石形成无关;等位基因 C 可能为痛风发病的风险因子,而 TT 基因型及 T 等位基因可能对痛风发病具有保护作用;其多态性可能通过影响 SLC2A9基因的转录表达水平来参与痛风的发病。