老年痛风的临床特点和治疗

目的探讨老年痛风的发病机理、临床特点和治疗方法。方法60岁以上痛风性关节炎患者138例。分析尿酸代谢情况，合并症及治疗效果。结果单关节受累62例(占44.9％)，多关节受累76例(占55.1％)。有肾结石者17例(占12.3％)，痛风石19例(占13.8％)。主要合并症为高血压病、冠心病、高脂血症和糖尿病。用苯溴马龙治疗后，症状好转，血清尿酸下降到正常〔治疗前(540.6±112.8)μmol/L，治疗后(252.0±73.2)μmol/L，P＜0.01〕，肾脏清除尿酸分数增加〔(6.6±3.7)％，(14.4±8.2)％，P＜0.01〕，内生肌酐清除率无明显变化。结论本文结果表明，本病的发病机理是肾脏清除尿酸能力下降，使用增加肾脏清除尿酸的药物有效。

Gout in the Elderly: the Clinical Manifestation and Treatment

Objective:To investigate the pathogenesis, clinical manifestation, and treatment of gout in the elderly. Methods: One hundred and thirty-eight primary gout patients were observed. All of them were over 60 years. The metabolism of uric acid, complication and the curative effect were analyzed. Results: Single-joint-arthritis was found in 44.9% patients and poly-joint-arthritis was 55.1 % . Four major complications were found which included primary hypertension, coronary heart disease, hyperlipdemia, and diabetes. After treatment with Benzbromarone, the arthritis disappeared and the serum urate acid decreased to normal from (540.6?112.8) jmnol/L to (252.0?3.2) nmol/L, P<0.01]. The FRUAC increased from(6.6?.7)% to (14.4 ?8.2)% (P<0.01). The change of Cr was not significant. Conclusion: The important pathogenesis of gout in the elderly is the inability of renal clearance under high urate acid load. Benzbromarone is an effective drug to treat gout in the elderly.