上中下通用痛风汤治疗高尿酸血症的实验研究

目的:探讨上中下通用痛风汤治疗高尿酸血症的作用.方法:采用腺嘌呤和乙胺丁醇联用,ig,连续21 d,建立高尿酸血症大鼠模型,上中下通用痛风汤高、中、低剂量组分别给予上中下通用痛风汤5,10,20 g·kg-1,ig,连续给药21 d后检测血清尿酸(UA)、黄嘌呤氧化酶(XOD)、腺苷脱氨酶(ADA)、尿素氮(BUN)、肌酐(Cre)水平.结果:与模型组大鼠血清UA(310.12 ±22.23) μmol·L-1比较,上中下通用痛风汤高、中、低剂量组,分别为(188.99±20.82),(202.56士19.77),(226.53±29.83)μmol·L-1水平显著降低(P＜0.05),且其降低UA效果高于别嘌呤醇组(P＜0.05);上中下通用痛风汤中剂量组XOD含量为(40.15 ±0.74) U·L-1,明显低于模型组(49.19±1.61) U·L-1 (P ＜0.05);上中下通用痛风汤高、中剂量组ADA含量为(24.02 ±0.32),(28.61±1.78) U·L-1,明显低于模型组(34.36±3.73)U·L-1(P＜0.05);上中下通用痛风汤高、中、低剂量组血清BUN及Cre水平,显著低于模型组(P＜0.05).结论:上中下通用痛风汤具有显著的抗高尿酸血症的作用,可显著降低血尿酸水平和降低尿酸生成,并对肾脏亦有保护作用.     

认知治疗改善痛风患者遵医行为的效果分析

目的探讨心理行为干预对痛风患者遵医行为的影响。方法 2006年1月-2010年9月,选取痛风患者190例,随机分为干预组和对照组,两组均进行遵医行为评价和疾病相关检查;对干预组进行认知行为干预,分析患者存在的痛风饮食治疗的认知误区,有针对性地进行心理行为干预。结果干预后,干预组认知行为总分和各单项分均高于对照组(P<0.05),胆固醇、甘油三酯和体质量指数均低于对照组(P<0.05);干预组19例(20.0%)复发,对照组36例(37.9%)复发,两组复发率比较,差异有统计学意义(χ2=7.390,P=0.007)。结论行为认知治疗可提高痛风患者的治疗依从性,从而有助于改善尿酸等相关指标。     

外伤后手足痛风误诊为外伤性骨感染

目的探讨外伤后手足痛风误诊原因,以提高认识及诊断水平。方法对我院收治的外伤后手足痛风3例的临床资料进行回顾分析。结果本组3例均为外伤后发现指（趾）末端肿痛,活动受限,病初均误诊为外伤性骨感染,后行手术治疗,术中所见及术后病理诊断为痛风,均痊愈出院。结论对痛风及外伤性骨感染认识不足,未行实验室相关检查,是造成误诊的主要原因。本病最终确诊仍须依据病理组织检查结果。     

痛风发生因素分析与预防对策

目的 加强痛风的预防,减少发病率.方法 对75例痛风患者的临床资料及发生因素进行分析总结,制定预防对策.结果 冠心病、高血压、高血脂症、肥胖和糖尿病等是痛风发作的危险因素,高嘌呤饮食、饮水量少、口服引起尿酸增多的药物、劳累、潮湿和寒冷等是诱发因素.结论 避免危险因素和诱发因素,能减少和防止痛风的发生.     

痛风患者颈动脉内膜-中膜厚度与UA、CRP水平的关系探讨

[目的]通过研究痛风患者颈动脉内膜-中膜厚度(IMT)与血尿酸(UA)、C反应蛋白(CRP)的关系,研究UA、CRP在痛风患者动脉粥样硬化的作用。[方法]60例痛风患者,正常对照组40例,分析2组人群空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、血尿酸、C反应蛋白,测定颈动脉内膜-中膜厚度,同时计算体重指数(BMI)。[结果]痛风患者组与正常组比较:年龄、FPG、TG、HDL-C、BMI无统计学差异(均P﹥0.05),UA、CRP、IMT有统计学差异(P﹤0.01或P﹤0.05)。痛风患者IMT与年龄、TC、TG、LDL-c、UA、BMI、CRP呈正相关(P﹤0.05或P﹤0.01)。[结论]UA、CRP水平升高与痛风患者动脉粥样硬化(AS)关系密切,关注痛风患者UA、CRP水平的升高对临床具有重要意义。     

Febuxostat: A Novel Agent for Management of Hyperuricemia in Gout

Gout is a metabolic disorder characterized by elevated uric acid levels in the body, associated with painful arthritis, tophi and nephropathy. The most frequently used pharmacologic urate lowering strategies involve reducing urate production with a xanthine oxidase inhibitor and enhancing urinary excretion of uric acid with a uricosuric agent. Urate lowering agents are limited in number, availability and effectiveness. The emergence of a new medication, febuxostat, to lower serum urate levels is welcome as no new drug have been approved since the introduction of allopurinol, in 1964, and the drugs that are available have limitations owing to inefficacy or toxicity. Febuxostat is a novel, nonpurine selective inhibitor of xanthine oxidase, is a potential alternative to allopurinol for patients with hyperuricemia and gout.     

A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma

Percutaneous radiofrequency thermal ablation(RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma(HCC) patients.Although RFA is generally well tolerated,recent studies have reported complications associated with RFA.We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency.Regular surveillance of the...     

Adherence with urate-lowering therapies among male patients with gout in a routine clinical setting

Objectives: To assess adherence (compliance and persistence) and factors that might contribute to nonadherence to urate-lowering therapies (ULT) in patients with gout in a routine clinical setting.

Methods: This prospective observational cohort study was conducted in the rheumatology center of a local tertiary hospital. A total of 132 male adults aged 75 years or younger who were incidentally diagnosed with gout were included. Adherence to ULT was assessed by the clinic nurses through pill counts.

Results: Of the 132 patients, 94 (71.2%) was compliant and 81 (61.4%) was persistent with ULT. The logistic regression analysis revealed that the absence of chronic kidney disease (CKD) and the previous history of non-persistence with ULT are the independent factors associated with noncompliance and the absence of CKD is an independent factor associated with non-persistence. The average serum urate levels of the noncompliant (p?=?0.001) and non-persistent (p?=?0.002) patients were significantly higher than those of the compliant and persistent patients.

Conclusions: The absence of CKD and the previous history of non-persistence of ULT that are correlated with poor adherence and easily assessed can be used to identify patients at a particular risk of poor adherence.     

Partners and nurses’ knowledge and representations of gout: A qualitative study

Adherence to gout treatment is poor. Partners of patients and nurses are two major communicators with gouty patients, and their perceptions of illness may affect patient behavior.ObjectiveTo explore partners’ and nurses’ knowledge and representations of gout.MethodsWe used a qualitative grounded approach with semi-structured face-to-face individual interviews with a purposive sample of hospital nurses working in rheumatology and internal medicine departments and patient partners. Interviews were audio-recorded and transcribed. All authors met regularly to discuss coding and data interpretation.ResultsOverall, 20 nurses and 12 partners participated in the interviews. Four major themes were evidenced: knowledge gaps (gout cause was unknown, unawareness of urate-lowering therapy and the possibility to cure gout, focus in gout flare and diet); lack of information and education on gout (knowledge acquired by personal experiences, nurses complained to be insufficiently educated, partners highlighted the lack of information and that general practitioners did not have time to educate patients); gout consequences and social impacts (handicapping disease, avoid social activities like dinner with friends); attitudes towards gout flare and patient management (feeling powerless during flare, negative feelings such as being ashamed leading to postpone medical seek or unconcerned about their partner disease). Nurses regretted that they had not enough time to discuss issues with patients.ConclusionPartners and nurses’ knowledge of gout is based on daily experiences. Participants were eager to learn more about gout. Nurses’ education and education programs including partners may improve gout management and patient adherence to treatment.