中国沿海地区汉族男性人群白细胞介素-1β-31C/T基因多态性与痛风的易感性研究

目的 探讨山东省沿海地区中国汉族男性群体的白细胞介素(IL)-1β启动子区rs1143627(-31C/T)基因多态性的分布状况及其与痛风易感性之间的关系.方法 选取208例痛风患者和210名健康对照者,应用聚合酶链反应限制性片段长度多态性(RFLP)技术,检测中国汉族男性群体的IL-1β启动子区rs1143627(-31C/T)位点基因多态性与痛风发病的遗传易感性的关系.采用Hardy-Weinberg检验确认标本的群体代表性,数据分析采用χ2检验和t检验.结果 痛风组中IL-1β启动子区-31C/T位点CC,CT和TT基因型分别为32.7%,43.3%和24.0%,健康对照组分别为31.9%,46.2%和21.9%,2组比较差异无统计学意义(χ2=0.427,P>0.05);2组的等位基因频率C和T间差异也无统计学意义(分别为54.3%,55.0%;45.7%,45.0%;χ2=0.038,P>0.05).经χ2检验,IL-1β基因-31C/T位点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-1β启动子区rs1143627(-31C/T)基因多态性与痛风有关联性.

Abstract：

Objective To explore gene polymorphism of the C/T genotype of rs1143627 in the promoter of IL-1β gene in male population living in the coastal area of Shandong, and thus to investigate the relationship between the gene polymorphism of IL-1β and gout. Methods A total of 208 gout patients and 210 healthy controls were enrolled. The possible association between the polymorphism of IL-1 β -3 1C/T and gout in Chinese were investigated and genotype frequencies and allelic frequencies was calculated by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) method. Hardy-Weinberg was used to verify the representativeness of the sample. Comparisons between the groups were performed with χ2 test and t-test. Results The frequencies of CC, CT, and TT genotypes were 32.7%, 43.3% and 24.0%,respectively among gout patients, while they were 31.9%,46.2% and 21.9%, respectively among the controls.There was no statistically difference in IL-1β -31C/T genotype frequencies between gout patients and controls (χ2=0.427, P>0.05). The allele frequencies of C and T in gout cases were different from those in the controls (54.3%, 55.0%; 45.7%, 45.0%; χ2=0.038, P>0.05). Moreover, no association between IL- I β-31 C/T genotypes and risk factors for gout were observed in gout cases by χ2 test. Conclusion Results of the present study suggest that the C/T genotype of rs1143627 in the promoter of IL-1β gene is not associated with gout in male population living in the coastal area of Shandong.     

饮食干预对高尿酸血症和痛风患者的疗效分析

目的探讨营养宣教和饮食干预在高尿酸血症和痛风患者治疗中的作用。方法对45例高尿酸血症和痛风患者进行营养宣教,比较宣教前后患者对高嘌呤食物的知晓率;对患者分别进行低嘌呤饮食或药物治疗,并进行疗效观察与比较。结果通过营养宣教,患者对高嘌呤食物的知晓率显著提高（P〈0．01）;饮食干预或药物治疗均能够有效改善患者症状,并使其血尿酸值显著降低（P〈0．01）。结论对高尿酸血症和痛风患者进行饮食宣教和营养干预,能够有效降低患者血尿酸值,改善患者的临床症状。     

针刺联合药物治疗痛风的临床观察

目的针刺联合药物治疗痛风的临床观察。方法采用随机对照的方法,将99例痛风患者随机分为针刺组、药物组、针刺联合药物组。结果3组治疗7d观察,疗效差异亦有统计学意义。针刺组与针刺加药物组（χ^2=15.28,P〈0.01）,药物组与针刺加药物组（χ^2=12.28,P〈0.01）,针刺加药物组明显优于针刺组和药物组。结论针刺联合药物组在治疗痛风的过程中,症状缓解快且不良反应少,效果显著。     

Gout Assessment Questionnaire: Initial results of reliability, validity and responsiveness

We evaluated the psychometric properties of a new gout-specific patient reported outcomes questionnaire. The Gout Assessment Questionnaire (GAQ) and the SF-36 were administered to 126 subjects in a multicenter Phase II program of febuxostat, an investigational treatment for hyperuricemia (serum uric acid >8.0 mg/dl) in patients with chronic gout. The questionnaire was administered at baseline and 1, 6 and 12 months later. The majority of subjects, mean age 54 years, were male, Caucasian and had experienced a gout flare within the last year. Seven domains were identified, all met criteria for reliability and validity. Cronbach's alpha ranged from 0.78 to 0.97. Pearson correlations between GAQ and SF-36 scales were generally low to moderate, with the highest correlation between Gout Pain and Severity and SF-36 Bodily Pain, r = 0.45. Guyatt's statistic (measure of responsiveness) ranged from 0.24 to 1.00 at 12 months. Minimal clinically important differences ranged from 2 (Gout Concern) to 10 points (Productivity). The GAQ has acceptable psychometric properties. Further research is required to confirm results, which may provide more information to improve the GAQ for use in clinical trials.     

针灸配合中药苦蝶子治疗急性痛风性关节炎

目的观察中医治疗痛风的有效治疗方法.方法中医认为痛风是痰湿内聚,瘀久化热,闭阻经脉,气血运行不畅而发病.临床上经过抽血化验尿酸增高,结合症状表现进行诊断.本文将46例痛风患者随机分为两组,中药治疗组(针刺和静点苦蝶子)和西药对照组(急性期给醋氯芬酸片,缓解期给别嘌呤醇口服).结果 治疗组总有效率95.65%,对照组总有效率82.60%,两组疗效有显著差异,治疗组疗效优于对照组.结论 针药并举安全有效,是治疗痛风的一个比较理想的方法.     

原发性痛风患者326例血尿酸、胱抑素C和脂代谢特点分析及其临床意义

目的 了解原发性痛风患者血尿酸（sUA）、血脂及血浆胱抑素C（CysC）的代谢特点,探讨痛风患者易并发心脑血管疾病的可能机制.方法 检测326例原发性痛风性关节炎（GA）患者和210例健康体检者sUA、CysC、胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、极低密度脂蛋白（VLDL）、载脂蛋白A1（apoA1）、载脂蛋白B100 （apoB100）、超敏C反应蛋白（hsCRP）浓度并完善血细胞计数,详细收集痛风患者临床资料;比较两组上述指标的差异并分析sUA、CysC与各指标的相关性.结果 痛风组sUA、CysC、hsCRP、WBC、中性粒细胞（GR）、体重指数、TG、TC、VLDL、apoB100、血糖、肌酐和尿素均显著高于正常对照组（P均＜0.01）,而淋巴细胞、HDL则显著低于对照组（P均＜0.01）.痛风组sUA与年龄、WBC、TG、VLDL、肌酐及CysC呈显著正相关（r=0.24、0.27、0.27、0.33、0.25、0.21,P均＜0.05）,与HDL-C呈显著负相关（r=-0.16,P＜0.01）;痛风组CysC与WBC、GR、单核细胞计数、apoA1、血糖、肌酐、尿素、hsCRP呈显著正相关（r=0.26、0.20、0.31、0.22、0.46、0.67、0.63、0.33,P均＜0.05）,与TC、LDL-C呈显著负相关（r=-0.25、-0.27,P均＜0.01）.结论 痛风患者血脂异常特点符合致动脉粥样硬化血脂谱的典型特征.痛风患者易出现脂代谢紊乱、易合并心脑血管疾病,可能与高尿酸血症致血管内皮损伤、平滑肌细胞增殖等血管长期慢性炎症反应有关.CysC可能可作为痛风早期肾功能损害及慢性炎症的判定指标.     

64例别嘌醇引起皮肤系统损害分析

目的:探讨别嘌醇引起皮肤系统不良反应的表现及发生规律,为临床安全用药提供参考。方法:我院不良反应监测系统2005年1月～2012年3月使用别嘌醇引起的皮肤系统不良反应病例进行统计分析。结果:共检索到ADR 64例,以中老年居多(51例,79.7%),其常用日剂量为50～100 mg(51例,79.7%),潜伏期2 d～4个月不等;皮肤系统ADR的临床表现以一般型、剥脱性皮炎型及多形红斑型的药疹为主,占73.4%,60%患者有伴随症状。结论:临床应重视别嘌醇皮肤系统不良反应的危害性。对老年患者更应注意密切观察用药后反应,确保用药安全。     

清热解毒利湿法治疗原发性痛风急性发作的临床研究

目的观察清热解毒利湿法治疗原发性痛风急性发作的临床疗效。方法60例原发性痛风急性发作患者随机分为2组。中药组30例运用清热解毒利湿法治疗,外敷金黄膏。西药组30例用秋水仙碱治疗。2组均用药1周后观察临床疗效及副反应情况。结果2组临床疗效比较无显著性差异（P〉0．05）;中药组未出现副反应,西药组有不同的副反应出现（P〈0.01）。结论清热解毒利湿法治疗原发性痛风急性发作的疗效良好,安全性高。     

羟氯喹对痛风患者血尿酸及血脂的影响

目的探讨羟氯喹治疗对痛风患者血尿酸(UA)和血脂的影响及其安全性。方法将2009年1月—2010年4月治疗的原发性痛风患者43例随机均分为治疗组和对照组,治疗组25例采用一般治疗+控制尿酸药+羟氯喹治疗,对照组18例采用一般治疗+控制尿酸药+小剂量秋水仙碱治疗,观察期6个月,比较2组血清尿酸和血脂的变化。结果 (1)血UA:2组治疗后3、6个月末较治疗前比较差异有统计学意义(P<0.05或P<0.01),且治疗组尿UA降低较对照组同时点明显(P<0.05或P<0.01)。(2)血脂:治疗组治疗后3、6个月末TC、LDL-C、HDL-C水平较治疗前比较差异有统计学意义(P<0.05或P<0.01),而对照组治疗前后变化不明显(P>0.05);治疗组治疗后3、6个月末TC、LDL-C、HDL-C水平较对照组同时点有显著差异(P<0.05或P<0.01)。急性痛风性关节炎复发次数减少,差异无统计学意义(P>0.05)。结论羟氯喹可减少痛风关节炎的发作次数及降低血尿酸、血脂,具有较好耐受性和安全性。     

高尿酸血症防治中应关注的几个关键问题

随着人们生活水平的提高和饮食结构的改变,高尿酸血症及其相关疾病的发病率急剧上升.由于多数患者处于无症状高尿酸血症状态,故尚未引起患者和医务工作者的重视.本文就高尿酸血症与痛风、肾损害、糖代谢紊乱、动脉粥样硬化性疾病的关系及其预防进行评论,以期提高广大临床医师对高尿酸血症的认识及对该病防治的重视.

Abstract：

The incidence of hyperuricemia and relevant diseases has been increasing recently since the living improvement and dietary changing. Both patients and doctors do not pay enough attention to this disease, due to the lack of obvious clinical presentations in early stage. This paper comments on the relationship between hyperuricemia and gout, gouty nephropathy, impaired glucose metabolism,and atherosclerotic diseases in order to arouse enough attention to this disease.