关节镜有限清理术等综合性措施治疗痛风性关节炎

目的探讨膝关节痛风性关节炎综合治疗中关节镜的作用和疗效。方法自2000年2月至2009年2月,对45例反复急性发作的膝关节痛风性关节炎患者进行关节镜诊治,利用刮匙除去紧密附着在负重面关节软骨上的尿酸盐结晶,对充血、增生的滑膜及其附着的尿酸盐结晶不予特殊处理;修整剥脱的关节软骨及受侵蚀的半月板;用大量冲洗液冲洗关节腔,最后关节腔内注射复方倍他米松注射液（得宝松）及罗哌卡因等复合药物。术后抗炎镇痛,合理饮食调节及降尿酸治疗。结果 45例患者术后病情均得到不同程度的缓解,28例患者随访期内未发生痛风急性发作。17例患者有2～3次的急性发作,与饮食控制不良和未坚持降尿酸治疗或患有高三酰甘油血症、肥胖等代谢性疾病有关。结论关节镜下手术治疗膝关节痛风性关节炎是一种起效快、微创、效果显著的方法,关节内对软骨、滑膜尽量少的干预及复合镇痛药物的应用,有效地缓解了疼痛。但关节镜微创治疗仅是综合治疗的一部分,尚需要合理饮食调节、降酸等配合治疗。     

多指标综合评分法优化痛风巴布剂的醇提工艺

目的 优选痛风巴布剂的最佳提取工艺。方法 以青藤碱、总生物碱的含量和干浸膏得率为评价指标,采用正交设计试验,考察乙醇浓度、乙醇用量、提取时间和提取次数对提取结果的影响,确定痛风巴布剂处方药材的最佳提取工艺。结果 痛风巴布剂的最佳提取工艺为65%乙醇,提取3次,每次6倍量溶剂,提取总时间为1.5 h,在该工艺条件下得到的青藤碱含量、总生物碱含量和干浸膏得率分别为2.79 mg·g^-1、1.22%和13.06%。结论 优选的醇提工艺稳定、可行。     

治疗痛风药物非布司他的临床应用与进展

为了更全面地了解治疗痛风新药非布司他（Febuxostat）的研发、临床应用信息,促进安全、合理用药,作者通过查阅大量的国内外文献,对非布司他基本情况、各国上市的时间、临床研究、安全性评价、注意事项等进行总结分析。非布司他作为新开发出来的治疗痛风的可选药物,疗效可靠,安全性较好,值得临床推广应用;作为新药,也应加强上市后的安全性监测。     

The effect of bariatric surgery on gout: a comparative study

BackgroundObesity is a risk factor for the development of gout. An increased incidence of early gouty attacks after bariatric surgery has been reported, but the data is sparse. The effect of weight loss surgery on the behavior of gout beyond the immediate postoperative phase remains unclear. The objective of this study was to evaluate the pre- and postoperative frequency and features of gouty attacks in bariatric surgery patients.MethodsCharts were reviewed to identify patients who had gout before bariatric surgery. Demographic and gout-related parameters were recorded. The comparison group consisted of obese individuals with gout who underwent nonbariatric upper abdominal procedures.ResultsNinety-nine morbidly obese patients who underwent bariatric surgery had gout. The comparison group consisted of 56 patients. The incidence of early gouty attack in the first month after surgery was significantly higher in the bariatric group than the nonbariatric group (17.5% versus 1.8%, P = .003). In the bariatric group, 23.8% of patients had at least one gouty attack during the 12-month period before surgery, which dropped to 8.0% during postoperative months 1–13 (P = .005). There was no significant difference in the number of gouty attacks in the comparison group before and after surgery (18.2% versus 11.1%, P = .33). There was a significant reduction in uric acid levels 13-months after bariatric surgery compared with baseline values (9.1±2.0 versus 5.6±2.5 mg/dL, P = .007).ConclusionThe frequency of early postoperative gout attacks after bariatric surgery is significantly higher than that of patients undergoing other procedures. However, the incidence decreases significantly after the first postoperative month up to 1 year.     

Urate transport in health and disease

Circulation of urate levels is determined by the balance between urate production and excretion, homeostasis regulated by the function of urate transporters in key epithelial tissues and cell types. Our understanding of these physiological processes and identification of the genes encoding the urate transporters has advanced significantly, leading to a greater ability to predict risk for urate-associated diseases and identify new therapeutics that directly target urate transport. Here, we review the identified urate transporters and their organization and function in the renal tubule, the intestinal enterocytes, and other important cell types to provide a fuller understanding of the complicated process of urate homeostasis and its role in human diseases. Furthermore, we review the genetic tools that provide an unbiased catalyst for transporter identification as well as discuss the role of transporters in determining the observed significant gender differences in urate-associated disease risk.     

La maladie goutteuse

Gout is a chronic disease due to the deposition of monosodium urate microcrystals in joints and tissues. Its incidence and prevalence are increasing worldwide in close relation with the epidemic of obesity and metabolic syndrome. Gout is related to chronic hyperuricemia that should be treated to ensure the reduction or even the disappearance of acute attacks (“gout flares”) and to reduce the size and number of tophi. If arthritis of the first metatarsophalangeal joint is the most typical form, other joints may be affected, including the spine. Demonstration of urate microcrystals arthritis allows diagnosis of gout but, in the absence of possibility of performing joint puncture, imaging may be useful for providing complementary diagnostic elements. Appropriate care is essential to reduce the number of flares and the evolution towards gouty arthropathy but also in terms of public health in order to reduce costs related to this pathology.     

痛风患者达标治疗的影响因素调查分析与护理对策

目的探讨痛风患者达标治疗的影响因素及护理对策。方法选取2017年9月至2019年3月我院收治的痛风患者100例为研究对象,对其痛风达标治疗相关影响因素的现状进行调查,包括一般人口学资料及病历资料。采用多因素logistic回归分析法对痛风患者治疗后未达标的相关危险因素进行分析,并制定相关护理措施。结果本组100例患者中未达标59例,多因素logistic回归分析显示,体质量和饮酒史是痛风患者治疗未达标的独立危险因素(P<0.05),医嘱执行和定期复诊是保护因素(P<0.05)。结论影响痛风患者达标治疗的因素较多,需结合其自身实际情况,制定个性化健康干预指导,提升其对痛风达标治疗的相关认知、治疗依从性和自我管理能力,从而改善达标治疗的现状,提高治疗效果。