自拟利湿泄浊消痹汤加减治疗痛风急性期关节炎疗效观察

目的:观察利湿泄浊消痹汤加减治疗痛风急性期关节炎的治疗效果。方法:将80例患者随机选取两组,每组选取40例,实验组:在应用秋水仙碱的基础上应用利湿泄浊消痹汤加减配合治疗,并根据不同的证型酌情加减用药,对照组:所有证型单纯应用秋水仙碱治疗,12周为一个治疗周期,治疗之后比较两组患者临床疗效、血尿酸(Blood Uric Acid,BUA)水平、C反应蛋(C-reaction Protein,CRP)、白细胞介素-4(Interleukin,IL-4)水平及不良反应发生情况。结果:实验组各证型总有效率明显高于对照组总有效率(P<0.05),血尿酸水平试验组显著低于对照组,差异有统计学意义(P<0.05),两组IL-4、CRP水平明显降低,且与对照组相比,试验组IL-4、CRP水平较低,差异具有统计学意义(P<0.05);试验组肝功能异常、肌酐升高、恶心呕吐等不良反应发生率稍低于对照组,两组比较无统计学差异(P>0.05)。结论:痛风患者急性期关节炎应用西药的基础上再配合利湿泄浊汤消痹加减治疗比单纯应用西药治疗效果更佳,可提高疗效,缩短疗程,并能减少治疗痛风西药的用量,从而减轻不良反应。     

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.     

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.     

Anti-inflammatory drugs as new inhibitors to xanthine oxidase: In vitro and in silico approach

The two important targets to treat gout disease are (1) control the hyperuricemia by the inhibition of Xanthine Oxidase (XO) and (2) treatment of acute attacks of gout by the use of anti-inflammatory drugs. It is important to distinguish between therapy to manage hyperuricemia and to reduce acute inflammation. While reducing hyperuricemia is resolved very slowly with available drugs, gout symptoms like pain and inflammation may become persistent. The objective of this study is to find a relevant treatment with a beneficial double effect. (1) As an anti-inflammatory, analgesic, and antipyretic effect and (2) as XO inhibitory effect, which is the main objective of this study. We investigated the effect of five non-steroidal anti-inflammatory drugs (NSAIDs) against human and bovine milk xanthine oxidases (HXO and BXO) using the double enzyme detection method (DED) and molecular docking with the Autodock vina program. in vitro results show that the NSAIDs give an important inhibition to HXO and BXO with an IC₅₀ of 2.04 ± 0.13 μg/ml, 2.75 ± 0.23 μg/ml, 1.45 ± 0.19 μg/ml, 0.31 ± 0.13 μg/ml and 1.27 ± 0.11 μg/ml, for HXO, and 2.96 ± 0.27 μg/ml, 9.46 ± 0.13 μg/ml, 6.21 ± 1.17 μg/ml, 0.83 ± 0.11 μg/ml, and 3.48 ± 0.13 μg/ml, for BXO, for respectively, Naproxen, Ibuprofen, Diclofenac, Indomethacin, and Celecoxib. Testing the inhibitory activity of these drugs on both XOs shows an important inhibition, especially from Indomethacin, which could be a promising lead compound for reducing acute inflammation and at the same time controlling hyperuricemia.     

痛风及高尿酸血症患者血清脂联素水平变化及相关因素分析

目的通过检测血清脂联素(APN)水平在痛风、高尿酸血症患者及正常人中的变化,分析其与临床及实验室指标之间的关系,探讨APN在痛风及高尿酸血症发病中的作用及意义。方法选择痛风组(Gout)和高尿酸血症组(HUA)患者各51例,正常对照组(NC)40例,采用ELISA酶联免疫吸附法(ELISA)测定血清APN水平,详细记录并分析患者的临床症状及各实验室指标。结果 1Gout组及NC组APN浓度均明显高于HUA组(P<0.05),痛风与NC组之间差异无统计学意义(P>0.05)。2NC组、HUA组与Gout组三组之间体重指数(BMI)、尿素氮(BUN)、肌酐(Cr)、胆固醇(TC)、甘油三酯(TG)、极低密度脂蛋白(VLDL)、ADN浓度相比差异有统计学意义(P<0.05);Gout组及HUA组BUN、TG、VLDL均明显高于NC组(P>0.05);Gout组BUN、Cr、GLU、APN明显高于HUA组(P<0.05),HUA组BMI明显高于NC组(P<0.05)。3APN与BMI、UA、TG均呈负相关,与VLDL呈正相关。结论 APN参与尿酸代谢紊乱的病理发病机构,与痛风的发生发展过程及代谢综合征指标密切相关。     

尿酸排泄分数与原发性痛风的相关性研究

目的探讨尿酸排泄分数与原发性痛风患者血尿酸、体质量指数（BMI）、血压、血糖以及血脂等代谢因素的相关性。方法选择62例原发性痛风患者为痛风组和32例健康体检者为对照组,痛风组患者按尿酸排泄分数水平分为尿酸排泄减少组29例（尿酸排泄分数〈7％）、混合组25例（7％≤尿酸排泄分数≤12％）和尿酸生成增多组8例（尿酸排泄分数〉12％）。抽取患者空腹血,检测血肌酐、血尿酸、血糖、糖化血红蛋白及血脂水平,留取24h尿,测得24h尿尿酸、尿肌酐,根据公式计算尿酸排泄分数并进行相关性分析。结果痛风组BMI、平均动脉压、血尿酸、糖化血红蛋白、总胆固醇、餐后2h血糖明显高于对照组,高密度脂蛋白胆固醇、尿酸排泄分数明显低于对照组,差异有统计学意义（P〈0．05）;两组年龄、空腹血糖、低密度脂蛋白胆固醇、三酰甘油比较差异无统计学意义（P〉0．05）。尿酸排泄减少组、混合组、尿酸生成增多组年龄、血尿酸、空腹血糖、餐后2h血糖、糖化血红蛋白、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇比较差异无统计学意义（P〉0．05）;三组BMI、平均动脉压、三酰甘油、尿酸排泄分数比较差异有统计学意义（P〈0．05）。对照组和痛风组,尿酸排泄分数与血尿酸均呈负相关（r=一3．900,一0．476,P〈0．05）。痛风组尿酸排泄分数与24h尿尿酸呈正相关（r=0．465,P=0．001）,与三酰甘油水平呈负相关（r=一0．304,P〈0．05）。痛风组Pearson相关分析显示尿酸排泄减少组（尿酸排泄分数〈7％）尿酸排泄分数与血尿酸呈负相关（r=一0．392,P〈0．05）,非尿酸排泄减少组（尿酸排泄分数≥7％）尿酸排泄分数与血尿酸呈正相关（r=0．437,P〈0．05）,而24h尿尿酸与血尿酸无相关性（P〉0．05）。多元logistic回归分析提示血?     

Association of nationwide insurance data and Google Trends for seasonality of gout in South Korea

Aim of the workTo assess whether there is seasonality in the internet search volume related to gout and whether this reflects the seasonal variation of the actual number of gout cases in South Korea according to the nationwide insurance data.Patients and MethodsThe number of gout cases was obtained from the Health Insurance Review and Assessment Service (HIRA) in South Korea between January 2015 and December 2019. Internet search query data for the search terms “gout” and “uric acid” were obtained from a publicly available search engine database, Google Trends, during the same period. The cosinor analysis was conducted to assess a potential seasonality in the number of gout cases and gout-related search volumes (RSV) in Google Trends.ResultsThere was a significant seasonality in the number of gout cases and RSV for the search terms “gout” and “uric acid”. For both analyses, summer was the peak season, and winter was the trough season. The month with the most gout cases was July with February having the least number of cases. The RSV of the terms “gout” (r = 0.47; p < 0.001) and “uric acid” (r = 0.56; p < 0.001) significantly correlated with the number of gout cases.ConclusionThe number of gout cases and internet search data related to gout showed seasonality with a peak in the summer months in South Korea. Google Trends data for seasonality of gout were correlated with the nationwide insurance data. Internet search data has the potential to act as complementary tool for investigating and monitoring gout.