扩张型心肌病并发痛风患者的心脏移植

目的 :报告 1例并发痛风的扩张型心肌病的心脏移植手术和进行痛风患者心脏移植的文献回顾。方法 :受体是扩张型心肌病并发痛风患者 ,供体是 5 0岁急性脑死亡患者。手术采用中度低温全麻体外循环 ,采用标准原位心脏移植手术方法。免疫抑制方案手术后早期采用骁悉 ,普乐可复和强的松 ,2周后改为硫唑嘌呤 ,环胞素 A和强的松。结果 :供体心脏热缺血时间为 2 min,冷缺血时间为 130 m in,升主动脉阻闭时间为 75 min,开放升主动脉后心脏自动复跳 ,循环平稳。应用呼吸机时间为 18h。患者在手术后 10 d出现一次急性痛风性关节炎发作 ,用万络治疗好转。患者于手术后 18d由隔离病房回到普通病房 ,病情稳定 ,血尿酸浓度正常 ,无关节症状。结论 :尽管痛风患者进行心脏移植有许多风险 ,手术后还涉及痛风控制药物和免疫抑制剂的相互作用 ,但是如果处理得当 ,还是能够取得良好的手术效果     

Erythrocyte complement receptor type 1 in non-SLE rheumatic diseases

Summary An investigation was conducted to measure the levels of erythrocyte complement receptor type 1 (CR1) in patients with various rheumatic diseases other than systemic lupus erythematosus, and to evaluate the clinical significance of this receptor in patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Erythrocyte CR1 was measured in 37 normal controls and 106 patients with various rheumatic diseases. The levels of erythrocyte CR1 decreased significantly in patients with AS, juvenile rheumatoid arthritis, Sjögren's syndrome, and RA, while there was no statistical difference in levels of erythrocyte CR1 between normal controls and patients with gouty arthritis. This suggests that erythrocyte CR1 deficiency may occur in immune-mediated rheumatic diseases, but not in nonimmune-mediated rheumatic diseases such as crystal-induced arthritis. In this study, we noted that the levels of erythrocyte CR1 were not related to the disease activity and severity of AS. The levels of erythrocyte CR1 were also not correlated with the clinical and laboratory parameters of disease activity in RA patients. However, there was a negative association between the levels of erythrocyte CR1 and titer of rheumtoid factor in RA patients. Further study is needed to determine whether or not the level of erythrocyte CR1 is related to prognosis in patients with RA.     

Acute gouty arthritis during pyrazinamide treatment: a case report

Gout is a disease caused by an inflammatory response to an aggregation of monosodium urate crystals that develop secondary to hyperuricemia. Throughout its natural history it has four stages: asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous gout. In this article, we report the case of a patient who had asymptomatic hyperuricemia secondary to pyrazinamide, which was prescribed for pulmonary tuberculosis, and had developed an acute gouty arthritis immediately after the “Feast of Sacrifice” due to a dietary excess of purine.     

Preliminary Study on the Role of Virtual Touch Tissue Quantification Combined with a Urinary β2-Microglobulin Test on the Early Diagnosis of Gouty Kidney Damage

The goal of the work described here was to evaluate the role of virtual touch tissue quantification (VTQ) combined with urinary β2-microglobulin (β2-MG) measurement in the early diagnosis of gouty kidney damage. Two hundred fifty-nine patients with gouty kidney damage and 200 healthy control subjects were tested. The shear wave velocity (SWV) of the renal parenchyma and sinus as determined with VTQ and the urinary β2-MG level of the two groups were analyzed. Although there were no significant differences in age, body mass index, creatinine level and blood urea nitrogen between the two groups (all p's > 0.05), the aforementioned parameters were higher in the group with gouty kidney damage than in the control group. Urinary β2-MG levels of the patients with kidney damage were significantly higher than those of the control subjects (t = 6.38, p < 0.01). The SWV of the renal parenchyma was higher than that of the sinus in both groups. Compared with controls, patients with kidney damage had significantly increased renal parenchyma and sinus SWVs (all p-values < 0.05). Urinary β2-MG level was positively linearly correlated with the SWV of renal parenchyma in patients with kidney damage (r = 0.442, p < 0.0001). However, there was no correlation between urinary β2-MG level and the SWV of the sinus in patients with kidney damage (r = 0). In the control group, there was no correlation between urinary β2-MG level and the SWV of the renal parenchyma or sinus. The elasticity of the kidney as determined with VTQ, combined with the urinary β2-MG level, may be helpful in the early diagnosis of gouty kidney damage.     

When gout involves the spine: Five patients including two inaugural cases

Spinal involvement is uncommon during gout and may raise diagnostic challenges. We describe five cases seen at a single center.MethodsWe retrospectively reviewed the medical charts of the five patients with spinal gout seen over a 3-year period.ResultsThere were four men and one woman with an age range of 52 to 87 years. One patient presented with acute neck pain and visualization by imaging studies of a discovertebral tophus, another had febrile arthritis of a lumbar facet joint, and a third presented with a synovial cyst in a lumbar facet joint. The remaining two patients had acute febrile discitis confirmed by magnetic resonance imaging, at the cervical spine and lumbar spine, respectively. Laboratory tests showed systemic inflammation in four patients and marked serum uric acid elevation in two patients. Only three patients reported a previous history of peripheral acute gout attacks. Specimens of the spinal lesions were obtained in three patients and consistently showed monosodium urate crystals with tissue inflammation or a tophus. The outcome was rapidly favorable, either with colchicine therapy alone in four patients or after surgical resection of a facet joint cyst (during surgery to stabilize the lumbar spine) in the remaining patient. The patient with neck pain due to a tophus experienced nerve root pain at the acute phase. No other neurological manifestations were recorded.ConclusionThese case reports illustrate the diagnostic challenges raised by spinal involvement due to gout. The spinal lesions can be inaugural, as seen in two of our five patients.     

依托考昔和美洛昔康治疗急性痛风的疗效及安全性

目的 探讨应用环氧化酶2抑制剂依托考昔和美洛昔康治疗患者急性痛风发作的疗效和安全性. 方法 选择我院诊断为痛风急性发作患者88例.分别给予依托考昔120 mg/d(依托考昔组,48例)和美洛昔康15 mg/d(美洛昔康组,36例)治疗,共7d,主要疗效依据为第2～5天患者对关节疼痛自我评分(0～4分Likert量表)结果,并监测实验期间的各项指标及不良事件,以评估其安全性. 结果 疼痛自我评分变化值依托考昔组为( - 1.66±0.58)分,优于美洛昔康(-1.38±0.44)分,差异有统计学意义(P=0.018);依托考昔组不良事件的发生率31.2％(15/48)与美洛昔康组33.3％(12/36)相似,差异无统计学意义(P- 1.000). 结论 依托考昔120 mg/d是治疗急性痛风的有效方案,其疗效优于美洛昔康,总体安全性及耐受性良好.     

非布司他治疗痛风的快速卫生技术评估

目的 基于快速卫生技术评估(HTA)方法,评价非布司他治疗痛风的有效性、安全性和经济性.方法 系统检索PubMed、Cochrane library等英文数据库和中国知网(CNKI)、万方数据等中文数据库.由2位评价者根据纳入与排除标准独立筛选文献、提取资料和评价质量后,对结果进行定性分析.结果 共纳入2篇HTA报告、...     

不同超声表现在慢性痛风性关节炎诊断中的价值

目的 探讨不同超声表现对慢性痛风性关节炎诊断的价值。 方法 将临床确诊的32例慢性痛风性关节炎与36例其他非痛风性关节病患者的多种超声表现进行比较,评估不同超声表现的诊断意义。应用logistic回归模型评估模型的预报能力,并绘制ROC曲线。 结果 32 例慢性痛风性关节炎与其他非痛风性关节病比较,关节软骨“双边征”,关节液内“暴雪样”回声,肌腱周围强回声这3种超声表现两组差异有统计学意义（P<0.05）。利用该回归模型对68例慢性痛风性关节炎与非痛风性关节炎进行预报,预报准确率高达95.59% (65/68)。ROC曲线下面积为0.987±0.011（P<0.05）,表明该模型的拟合效果较好, 可用于预测慢性痛风性关节炎。 结论 关节软骨“双边征”,关节液内“暴雪样”回声,肌腱周围强回声这3种超声表现具有诊断价值,联合后可成为诊断慢性痛风性关节炎的重要影像学检查方法。     

The concept of the inflammasome and its rheumatologic implications

The inflammasome is a proteolytic complex that regulates IL1β and IL-18 secretion in macrophages and dendritic cells. Its plays a vital role in the control of the inflammatory and cellular responses to infectious and danger signals and is an essential part of the innate immune system. Four different inflammasomes have been identified so far, and the NLRP3-inflammasome has been the best-studied in relation to human disease. Activation of the NLRP3-inflammasome by microcrystals, such as monosodium urate (MSU) and basic calcium phosphate (BCP) crystals, leads to IL1β release, which in turn triggers local inflammation. Dysfunction of the NLRP3-inflammasome due to mutations of the NLRP3 gene is the cause of the auto-inflammatory syndrome CAPS. The symptoms and signs of inflammation in both conditions respond to IL1 blockade. IL1 inhibitors have also been used successfully in other idiopathic inflammatory diseases, suggesting that dysregulated inflammasome activity contributes to the pathogenesis of multiple diseases, but the precise underlying mechanisms remain to be identified.     

Gout tophus detection—A comparison of dual-energy CT (DECT) and histology

Objectives

To compare dual-energy CT images (DECT) directly with gold standard histology.

Methods

A 85-year-old woman with chronic recurrent gouty arthritis and macroscopically visible tophi was assessed with DECT-scans of her feet. When she died 7 days later, three tophi in different regions and in different tissues of her left foot were processed for histological examination.

Results

Of the selected tophi, two were almost completely missed by the color-coding DECT sequences. The tophi remained in most of their volume below the detection threshold value of 150 HU (default value).

Conclusions

It could be demonstrated that DECT only highlights the dense tophi (corresponding of approximately 15–20 vol% urate in the tophus). Less dense tophi, despite considerable size, will be missed in the color-coded images.