第一跖趾关节痛风性关节炎与无症状高尿酸血症的超声对比分析

目的 探讨高频超声在第一跖趾关节(MTP1)痛风性关节炎与无症状高尿酸血症中的诊断与鉴别诊断价值。方法 回顾性分析2013年1月-2016年6月我院46名痛风患者和58名无症状高尿酸血症者的MTP1超声声像图,并与68名健康志愿者进行对照,观察双轨征、滑膜增厚、滑膜炎、关节腔积液、痛风石、骨侵蚀、暴风雪征等超声征象并进行对比分析。结果 与健康志愿者相比,痛风组：痛风石38例(82.61%)、双轨征17例(36.96%)、骨侵蚀32例(69.57%)、滑膜增厚28例(60.87%)、滑膜炎20例(43.48%)、关节腔积液18例(39.13%)、暴风雪征5例(10.87%),差异均有统计学意义(P＜0.05),无症状高尿酸血症组双轨征21例(36.21%)、关节腔积液28例(48.28%),差异均有统计学意义(P＜0.001);与无症状高尿酸血症组相比,痛风组患者更易出现痛风石、骨侵蚀、滑膜增厚、滑膜炎,差异均有统计学意义(P＜0.001)。 结论 患者第一跖趾关节(MTP1)出现痛风石、双轨征、骨侵蚀、滑膜增厚、滑膜炎对于临床诊断痛风有意义,而双轨征和关节腔积液对于临床诊断无症状高尿酸血症有意义,痛风石、骨侵蚀、滑膜增厚、滑膜炎是鉴别诊断痛风与无症状高尿酸血症的相对可靠指标。     

Updates on the treatment of gout,including a review of updated treatment guidelines and use of small molecule therapies for difficult-to-treat gout and gout flares

Introduction: Gout is a rheumatologic condition associated with elevated serum uric acid levels and deposition of monosodium urate crystals in joints and soft tissues.

Areas covered: In this article, we describe the role of currently available drug therapies for managing acute gout flares and used in reducing serum urate levels. Further, we explore the role of novel small molecular therapies and biologic agents in the treatment of refractory or severe gout symptoms. A literature search of MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations Databases (1996-June 2017) was conducted utilizing the key words ‘gout’, ‘interleukin-1 inhibitors’, ‘acute gout’, ‘gout treatment’, ‘urate lowering therapies’, ‘hyperuricemia’, ‘colchicine’, ‘pegloticase’, ‘lesinurad’, ‘xanthine oxidase’, ‘xanthine oxidase inhibitors’, ‘allopurinol’, ‘febuxostat’, ‘uricosurics’, ‘probenecid’, and ‘benzbromarone’. All published articles regarding therapeutic management of gout and hyperuricemia were evaluated. References of selected articles, data from poster presentations, and abstract publications were additionally reviewed.

Expert opinion: Numerous therapies are currently available to managing acute gout flares and for lowering serum urate levels; advances in the understanding of the pathophysiology of this disorder has led to the emergence of targeted therapies and novel biologic preparations currently in development which may improve the clinical management of severe or refractory cases of disease that fail to respond to traditional therapies.     

血清降钙素原水平在鉴别慢性痛风急性发作和细菌感染中的价值

目的 探讨血清降钙素原(PCT)水平在鉴别慢性痛风急性发作和细菌感染中的价值.方法 选取原发性痛风急性发作病人152例,根据病人入院时是否体温≥37.5 ℃,将病人分为不伴发热组(n=35)和伴发热组(n=117),不伴发热组均排除细菌感染,根据临床症状、影像学、病原学检查结果及抗生素治疗有效,将伴发热组进一步分为细菌感染组(n=37)和非细菌感染组(n=80),收集临床资料,检测白细胞(WBC)计数、中性粒细胞比例及血清C-反应蛋白(CRP)和PCT水平,利用受试者工作特征曲线(ROC曲线)分析不同指标在鉴别慢性痛风急性发作和细菌感染中的价值.结果 伴发热组病人伴发高血压比例和痛风石破溃比例分别为47.9%、61.5%,均高于不伴发热组的25.7%、34.3%,均差异有统计学意义(χ2=8.233、P=0.041,χ2 =9.528、P=0.023);伴发热组病人血清PCT、CRP和中性粒细胞比例分别为(1.37±0.50)μg·L-1、(13.24±4.45)mg·L-1、(0.84±0.08),均高于不伴发热组,均差异有统计学意义(P<0.05),与非细菌感染组相比,细菌感染组病人血清PCT、CRP和中性粒细胞比例均升高,均差异有统计学意义(P<0.05);ROC曲线分析显示,血清PCT在鉴别慢性痛风急性发作和细菌感染时,曲线下面积0.821(95%CI:0.725~0.916),当血清PCT取界值1.56 μg·L-1时,灵敏度70.3%,特异度90.0%;CRP、WBC和中性粒细胞比例在鉴别慢性痛风急性发作和细菌感染时,曲线下面积分别为0.662(95%CI:0.554~0.769)、0.597(95%CI:0.479~0.714)和0.676(95%CI:0.566~0.787),灵敏度分别为51.4%、59.5%和73.0%,特异度分别为80.0%、70.0%和63.7%.结论 痛风急性发作不伴发热病人血清PCT水平显著低于伴发热病人,且低于细菌感染者,血清PCT可作为鉴别痛风急性发作和细菌感染的有效的血清学标志物.     

基于数据挖掘技术的中医药治疗痛风临床用药分析研究

目的运用计算机编程程序及数据挖掘技术,分析中医在辨治痛风过程中临床用药的客观规律,从而为提高临床疗效提供科学的依据。方法收集目前中医治疗痛风临床经验的资料,用自行开发的计算机软件进行处理、统计分析。结果经过计算机数据分析后得出中医药治疗痛风的临床用药规律。结论采用计算机数据挖掘分析中医药治疗痛风临床用药的客观规律,具有一定的科学依据。     

痛风患者的中医辨证施护

目的：探讨对痛风患者进行中医辨证施护的疗效.方法：将214例痛风患者随机分为观察组和对照组,对照组患者只接受西医常规护理,观察组在西医护理基础上接受中医辨证分型护理.结果：观察组治疗有效率显著高于对照组.结论：对痛风患者施以中医辨证施护,具有改善症状、防范并发症、减少西药用量等提高疗效的作用,而且能帮助患者养成良好的生活习惯,降低复发率.     

综合疗法治疗痛风随机平行对照研究

[目的]观察综合疗法治疗痛风疗效。[方法]使用随机平行对照方法,将62例门诊及住院患者按随机数字表法分为两组。对照组31例吲哚美辛,25mg/次,12h/次。治疗组31例中医综合治疗:①针灸:三棱针点刺八风、八邪、四缝放血,进针深度0.1~0.2寸,隔日1次;②中药外敷:消瘀散烘干研粉,混合后取适量,陈醋和蜂蜜调糊,敷在患处,纱布固定,持续陈醋浇纱布上,隔日1次;③刮痧:山茶油少量,涂抹于患处,刮痧板从上到下,从重到轻反复刮拭患处,以患处出现痧疹、痧斑为止;④中药外洗:痛风洗剂,温水融化,药物浸洗患处,30min/次,早晚各1次。连续治疗6d为1疗程。观测临床症状、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效12例,有效18例,无效1例,总有效率96.77%。对照组显效8例,有效17例,无效6例,总有效率80.65%。治疗组疗效优于对照组(P0.05)。[结论]综合疗法治疗痛风效果显著,值得推广。     

痛风患者饮食治疗知识掌握情况及依从性的调查研究

目的调查研究痛风患者饮食治疗知识掌握情况及依从性情况。方法选取2010年1月-2011年12月进行治疗的240例痛风患者为研究对象,然后将不同文化程度及病程患者的饮食治疗知识掌握情况及治疗依从性进行统计及比较,并将其生存质量及疾病控制效果进行研究及比较。结果文化程度较高及病程较长者的饮食治疗知识掌握情况及治疗依从性均好于文化程度较低及病程较短者,生存质量及疾病控制效果也优于文化程度较低及病程较短者,P均<0.05,差异有统计学意义。结论痛风患者的文化程度及病程对其饮食治疗知识掌握情况及依从性有较大影响,从而影响到其疾病控制效果及生存质量。     

Gout: Current Insights and Future Perspectives

Gout is a relatively common inflammatory arthritis that is typically known to occur in middle-aged men. The prevalence of gout appears to be shifting, however, and is increasing in the elderly population. Gout is characterized by severely intense pain and can greatly impact patient quality of life. The study of gout and associated conditions appears to have received research attention in the past, however there is a resurgence in gout interest due to the abundance of novel evidence surrounding its diagnosis, pathophysiology, and treatment. In this review we describe a general overview of gout including its assessment/diagnosis, clinical presentations, predisposing factors, pathophysiology, abortive and prophylactic therapy to control gouty inflammation, and the potential future direction of gout treatment.

Perspective

Gout is an underappreciated and extremely painful condition. Over the last 2 years new thought on pathophysiology of gout taking into account the inflammasome and new therapeutic agents have changed management strategies.     

原发性高尿酸血症及痛风易感基因研究进展

原发性高尿酸血症及痛风为多基因遗传性疾病.近期对该病进行的全基因组关联分析(GWAS)发现了多个与尿酸排泄及痛风发病相关的基因,为该病的病因学研究、疾病风险预测及防治提供了新思路.本文就此作一综述.

Abstract：

Primary hyperuricemia and gout are multifactorial conditions with strong genetic components. recently genome-wide association studies (GWAS) have revealed that several genes are related to primary hyperuricemia and gout which offers a thought for the research into the etiology, disease risk prediction, and prevention and treatment of this disease.     

高尿酸血症及痛风的遗传学背景和防治

高尿酸血症和痛风的发病率旱逐年上升趋势,其遗传学研究和防治工作也受到越来越多的关注.以下探讨了从人类尿酸形成的遗传学背景,总结了可能引起高尿酸血症形成的机制;从改变生活和药物治疗两个方面综述了防治高尿酸血症和痛风的研究进展.