Interleukin-1β gene polymorphisms in Taiwanese patients with gout

The purpose of this study was to examine whether interleukin-1 beta (IL-1) promoter and exon 5 gene polymorphisms are markers of susceptibility or clinical manifestations in Taiwanese patients with gout. The study included 196 patients in addition to 103 unrelated healthy control subjects living in central Taiwan. From genomic DNA, polymorphisms of the gene for IL-1 promoter and IL-1 exon 5 were typed. Allelic frequencies were compared between the two groups, and the relationship between allelic frequencies and clinical manifestations of gout was evaluated. No significant differences were observed in the allelic frequencies of the IL-1 promoter between patients with gout and healthy control subjects. Additionally, we did not detect any association of the IL-1 promoter genotype with the clinical and laboratory profiles of gout patients. However, there was a significant difference between the two groups in terms of hypertriglyceridemia (P=0.0004, ²=12.52, OR 7.14, 95%CI 0.012–0.22). There was also a significant difference in the genotype of IL-1 exon 5 polymorphism between patients with and without hypertriglyceridemia. Results of the present study suggest that polymorphisms of the IL-1 promoter and IL-1 exon 5 are not related to gout patients in central Taiwan.     

高尿酸血症与恶性肿瘤的关系与治疗概述

高尿酸血症是代谢异常性疾病,其可继发痛风、急性肾损伤、加重冠心病和高血压、诱发或加重糖尿病等,尤其是近代研究指出其可能加速肿瘤进展、增加癌症患者的死亡风险.另外,本无高水平尿酸的癌症患者,又可因为多种原因导致高尿酸水平升高,故对恶性肿瘤患者的高血尿酸的及时控制、治疗十分重要.     

Association of baseline disease and patient characteristics with response to etoricoxib and indomethacin for acute gout

ABSTRACT

Background and objective: Disease history and clinical features can influence treatment response in patients with acute gout. The purpose of this pooled subgroup analysis was to assess the association of baseline disease and patient characteristics with response to treatment in acute gout using data from two identical studies.

Methods: Patients ≥ 18 years of age with onset of acute gout within 48?h associated with moderate, severe, or extreme pain involving less than four joints were eligible for inclusion in the primary studies, and were randomized to etoricoxib 120?mg once daily (N = 178) or indomethacin 50?mg three times daily (N = 161). The primary and secondary efficacy endpoints were analyzed using an analysis of covariance model to detect potential differential treatment responses across several subgroups: joint involvement (mono-articular vs. oligo-articular), baseline pain severity (moderate vs. severe), concomitant allopurinol and/or colchicine use (users vs. nonusers), age (< 45, 45–55, and > 55 years), gender, and race (white or other).

Results: Overall, etoricoxib and indomethacin demonstrated comparable efficacy across all subgroups. Compared with patients with oligo-articular disease, those with mono-articular disease had significantly greater improvements in patient assessment of pain, patient global assessment of response to therapy (PGART), investigator global assessment of response to therapy (IGART), and study joint tenderness (?p < 0.001 for all). Greater improvements were seen in patient assessment of pain (?p < 0.001) and study joint tenderness (?p < 0.05) for severe/extreme baseline pain compared with moderate baseline pain. Concomitant use of colchicine and/or allopurinol was associated with significantly worse IGART (?p < 0.05).

Conclusions: This pooled subgroup analysis demonstrated significantly greater response of acute gout to either etoricoxib or indomethacin among those with monoarticular disease, severe/extreme baseline pain, and non-use of colchicine and/or allopurinol. These results should be interpreted in the context of a pooled subgroup analysis with a limited sample size, and with the understanding that associations identified in such analyses do not define causation. Despite limitations, the results provide insights into the types of patients more likely to respond better to anti-inflammatory medication, and reiterate the importance of earlier effective control of the disease.     

A case of ochronosis with gout and monckeberg arteries

Alkaptonuria is an inborn error of amino acid metabolism. A defect in tyrosine metabolism that results in accumulation of homogentisic acid in connective tissue, especially cartilage, has long been known. Degenerative arthropathy, especially of the knee and spine, develops at a relatively early age in adults. Accumulation also occurs in heart valves, and there may be a predisposition to atherosclerosis. We describe a 72-year-old man with ochronosis, gouty arthritis of both hands, and monckeberg arteries.     

痛风系列颗粒对原发性痛风患者胰岛素抵抗的影响

目的 探讨原发性痛风与胰岛素抵抗(insulin resistance,IR)之间的相关性,观察痛风系列颗粒对原发性痛风患者IR的影响。方法 原发性痛风患者和同期健康体检者各60例,分别检测两组人群血压（BP）、血尿酸(sUA)、空腹血糖(FPG)、空腹血胰岛素(FINS)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血瘦素(FL)、C肽（CP）、体重指数（BMI）、腰臀比（WHR）、胰岛素抵抗指数（IRI）和胰岛素敏感指数（ISI）等指标,进行Pearson相关性分析和多元逐步回归分析。将60例原发性痛风患者随机分为治疗组和对照组,每组各30例,治疗组给予虎杖痛风颗粒、茵连痛风颗粒治疗,对照组给予双氯芬酸钠双释放胶囊、苯溴马隆片治疗;并于治疗12周后评价两组患者上述指标的变化。结果 原发性痛风患者sUA、FPG、TC、TG、LDL-C、FINS、CP、FL和IRI、BMI、WHR均高于健康志愿者(P＜0.05）,而HDL-C、ISI低于健康志愿者(P＜0.05）。Pearson相关分析显示,sUA与FPG、FINS、IRI、BMI、TC、TG、LDL-C、CP、FL、收缩压（SBP）、舒张压（DBP）之间呈正相关（r 分别为0.444,0.496,0.660,0.542,0.414,0467,0.344,0.470,0.419,0.275,0.330,P＜0.05）,而与ISI（取对数）、HDL-C呈负相关（r分别为－0.569,－0.264, P<0.05）。以sUA为因变量进行多元逐步回归分析结果显示,sUA与IRI、TG和BMI仍呈正相关（r分别为5.758,2.849,3.425,P＜0.05）。治疗12周后,治疗组在TC、TG、FINS、FPG、IRI降低幅度和HDL-C、ISI增高幅度方面优于对照组（P＜0.05）。结论 原发性痛风患者胰岛素敏感性降低,存在IR;痛风系列颗粒具有一定的增强胰岛素敏感性和改善IR的作用。     

脑血管疾病合并痛风15例

为了探讨脑血管疾病合并痛风的临床特点及两者间的关系，回顾性调查痛风患者150例，均经血尿酸、肾功能、血糖、血脂及头颅CT或头颅MRI等多项检查发现痛风合并脑血管病患者15例，痛风合并脑卒中发生率为10%.15例患者中14例为男性，1例为女性，平均年龄69.3岁，均为沿海地区人。脑梗死9例，短暂性脑缺血发作4例，脑出血2例，4例患者系多次卒中。在既往史中8例有高血压病，5例有心脏病，3例有糖尿病及3例有高血脂，其中4例同时伴有高血压和心脏病或糖尿病。表明脑卒中合并痛风以沿海地区老年男性患者为多，缺血性常见。且常伴发高血压病、心脏病、糖尿病及高血脂等病史。卒中发作与急性痛风发作有关。痛风可能是沿海地区脑血管疾病的主要危险因素之一。     

新疆汉、维吾尔、哈萨克族成年人高尿酸血症及痛风的流行病学调查

应用四阶段整群随机抽样法,在新疆地区调查了13 559名汉、维吾尔、哈萨克族成年人的高尿酸血症及痛风患病率.汉、维吾尔、哈萨克族高尿酸血症标化患病率分别为11.00%、3.27%和3.94%;痛风患病率分别为1.32%、0.65%和0.70%,差异均有统计学意义(均P＜0.05).非条件logistic回归分析显示,维吾尔族及哈萨克族患高尿酸血症的风险较汉族低;体重指数、肾功能及血脂为高尿酸血症的危险因素;女性及体力活动为保护因素.食海鲜及动物内脏是汉族患高尿酸血症的独立危险因素,食动物内脏及饮酒是哈萨克族的独立危险因素.

Abstract：

Four-stage selected random samples were used to analyze the prevalence and distributing feature of hyperuricemia and gout in 13 559 Han,Uighur,and Hazakh adults in Xinjiang. The prevalence of hyperuricemia was 11.00%,3.27%,and 3.94% respectively in Han,Uighur,and Hazakh populations,and 1.32%, 0.65%,and 0.70% for gout,with statistically significant difference among three groups(all P＜0.05). No-conditional logistic regression analysis showed that nationality,body mass index,renal function,and serum lipid were risk factors of hyperuricemia,while female and physical activity were protective factors. Eating seafood and animal visceral organs were independent risk factors of hyperuricemia in Han population. Eating animal visceral organs and drinking alcohol were independent risk factors of hyperuricemia in Hazakh population.     

小剂量秋水仙碱联合别嘌呤醇在老年痛风患者中疗效及安全性观察

目的 分析小剂量秋水仙碱联合别嘌呤醇治疗老年痛风的疗效及安全性。方法 采用随机数字表法将我院于2019年12月—2020年12月收治的68例老年痛风患者分为对照组和观察组各34例,两组均采取常规对症治疗,对照组在常规对症治疗基础上联合使用别嘌呤醇,观察组在对照组基础上联合使用小剂量秋水仙碱,对比两组疗效、疼痛情况、血常规指标、炎症因子、不良反应发生率。结果 观察组治疗总有效率较对照组更高(P<0.05);观察组关节疼痛发作次数较对照组更少,且治疗后数字评价量表(NRS)评分更低(P<0.05);观察组治疗后尿酸、红细胞沉降率均较对照组更低(P<0.05),两组治疗后肌酐水平无统计学差异(P>0.05);观察组治疗后肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-17(IL-17)均较对照组更低(P<0.05);观察组恶心呕吐、上腹部不适、肝肾异常等不良反应总发生率较对照组更低(P<0.05)。结论 老年痛风患者给予小剂量秋水仙碱联合别嘌呤醇治疗可有效控制症状,减轻疼痛程度,减少疼痛发作次数,改善血管内皮功能,抑制炎症因子表...     

肾移植术后痛风的治疗

目的 探讨肾移植术后痛风的发生机制及防止策略.方法 分析512例肾移植患者的临床资料.结果 其中发生痛风性关节炎有35例,随访1～5年,4例症状控制不理想,余血尿酸控制在正常范围.结论 高尿酸血症及痛风是肾移植术后较常见的并发症,主要与患者肾功能减退、长期应用环孢素A(CaA)和利尿剂有关.患者的用药及饮食指导可降低痛风的发生.