丙磺舒联合别嘌呤醇治疗痛风间歇期临床研究

目的：探讨丙磺舒联合别嘌呤醇在痛风间歇期临床治疗中的应用。方法整群选取大庆市第五医院2014年1月—2015年9月收治的81例痛风性关节炎患者(均处于痛风间歇期)为研究对象,随机分为两组进行治疗,观察组的41例患者单独采用别嘌呤醇进行治疗,治疗组的40例患者应用丙磺舒联合别嘌呤醇进行治疗,并比较了两组患者治疗后的疗效和血尿酸值。结果经治疗,对照组总有效率78.04%,治疗组总有效率95%,治疗组疗效明显优于对照组,差异具有统计学意义(P<0.05);治疗后,对照组血尿酸水平由(680.24±78.53)μmol/L下降到(380.43±52.14)μmol/L,治疗组血尿酸水平由(684.37±75.42)μmol/L下降到(313.49±45.75)μmol/L,两组患者血尿酸水平均有下降,治疗前后差异具有统计学意义(P<0.05),而且治疗组血尿酸下降幅度明显高于对照组,差异具有统计学意义(P<0.05)。结论在痛风性关节炎患者的临床治疗中应用丙磺舒联合别嘌呤醇进行治疗,疗效明显,充分降低了血尿酸值,值得在临床上推广应用。     

益气养阴法治疗气阴两虚型慢性尿酸性肾病临床观察

目的 :观察益气养阴法治疗气阴两虚型慢性尿酸性肾病的临床疗效。方法 :将 5 2例慢性尿酸性肾病患者随机分为治疗组 (32例 )和对照组 (2 0例 ) ,治疗 2月后进行总疗效、临床症状、血尿酸、血肌酐、尿素氮、尿蛋白水平的评估。结果 :治疗组与对照组的有效率比较 ,有显著性差异 (P <0 .0 5 ) ;临床症状积分比较 ,治疗组优于对照组 (P <0 .0 5 ) ;在改善血肌酐、尿素氮、降低尿蛋白方面 ,治疗组均优于对照组 (P <0 .0 5 )。结论 :益气养阴法治疗气阴两虚型慢性尿酸性肾病疗效满意。     

泼尼松联合碳酸氢钠与别嘌呤醇治疗IgA肾病合并高尿酸血症的临床效果观察

目的 观察泼尼松联合碳酸氢钠与别嘌呤醇治疗IgA肾病合并高尿酸血症的临床效果。 方法 IgA肾病合并高尿酸血症的患者90例,随机分为研究组和对照组,各45例。对照组进行泼尼松口服治疗,研究组在此基础上采用碳酸氢钠与别嘌呤醇的联合治疗,所有患者均治疗8w。比较治疗前后两组患者的血肌酐(Scr)、血尿酸(UA)、总胆固醇(TC)和低密度脂蛋白(LDL)、24 h尿蛋白定量和肾小球滤过率(glomerular filtration rate,GFR)等指标的变化。 结果 经治疗,两组患者的Scr、UA、TC、LDL和24 h尿蛋白定量均低于治疗前(P<0.05),GFR高于治疗前(P<0.05);且治疗后研究组患者的Scr、UA、TC、LDL和24h尿蛋白定量均低于对照组(P<0.05),GFR高于对照组(P<0.05),以上均差异有统计学意义;研究组患者并发症发生率略低于对照组(P>0.05),即研究组的安全性略高于对照组,但是差异无统计学意义。 结论 泼尼松联合碳酸氢钠与别嘌呤醇治疗IgA肾病合并高尿酸血症,能有效降低患者的血肌酐和血尿酸,并能降低患者的血脂水平,有效改善患者的蛋白尿和肾小球滤过情况,临床效果显著,值得推广应用。     

A study of dose-response relationships of allpurinol in the presence of low or high purine turnover

Summary Effects of allopurinol (125–500 mg/m² body surface) were studied in normal subjects during periods of 18 days both during a purine-free, isoenergetic liquid formula diet and additional intake of ribonucleic acid, 4 g/day. Plasma uric acid and renal excretion of uric acid, oxypurines (hypoxanthine plus xanthine) and orotic acid were measured and total purine excretion calculated. Effects of allopurinol were evaluated by comparison of the results obtained in the steady state during diet alone (average of days 7–10) with those during allopurinol administration (days 16–18).During the purine-free diet, plasma uric acid was lowered more than urinary uric acid by allopurinol on doses of 250–500 mg/m² (44%–54% of control values on 500 mg/m²), demonstrating an increase in renal clearance. At the same dose, the uric acid lowering effect of allopurinol was more pronounced with than without purine loads (plasma 41%, urine 32% of control on 500 mg/m² during purine intake), while renal uric acid clearance was decreased. The more pronounced reduction of uric acid excretion during purine administration was balanced to the greater part by a more pronounced increased in oxypurine excretion. Total purine excretion was reduced by about 20% during the purine-free diet irrespective of dose. The size of this purine deficit was doubled, but was also independent of dose during addition of purines. Orotic acid excretion increased with dose during allopurinol treatment and was reduced by addition of purines.With respect to uric acid lowering effects, these results are in accordance with findings in patients overproducing uric acid endogenously and suggest that the uric acid lowering effect of allopurinol is enhanced with increasing concentrations of purine bases, presumably due to the tight binding of oxipurinol to xanthine oxidase. The small uricosuric effect of allopurinol seen during ingestion of the purine-free diet possibly is attributable to drug-induced orotic aciduria. The increase in size during purine intake of the purine deficit may result from reduced absorption of dietary purines during allopurinol treatment. Apparently, maximum effects of allopurinol on endogenous synthesis and/or absorption of purines from the gut are exerted by low doses.Abbreviations HPRT Hypoxanthine phosphoribosyl transferase - PRPP Phosphoribosyl pyrophosphate - RNA Ribonucleic acid This study was supported in part by grants of the Deutsche Forschungsgemeinschaft and Deutsche Wellcome GmbHDedicated to Prof. Nepomuk Zöllner on the occasion of his 65th birthday     

别嘌呤醇致药物超敏综合征1例

报告1例别嘌呤醇所致药物超敏综合征。患者男,49岁。因"痛风"口服别嘌呤醇半月,停药数天后,全身出现皮疹。皮肤科情况:头面、躯干、四肢可见簇集米粒大小红色斑丘疱疹,群集分布,部分融合成斑块,双下肢见紫癜样皮疹。右中腹皮损组织病理示:真皮乳头层高度水肿,部分形成表皮下水疱,真皮浅层血管周围淋巴细胞浸润。     

自由基在肾缺血再灌流损伤中作用的实验研究

本实验选用大鼠右肾切除、左侧肾蒂夹闭60min肾缺血模型,观察缺血、再灌流、再灌流加别嘌呤醇(AP)和再灌流加超氧化物歧化酶(SOD)对动物血清肌酐(Scr)、肾系数和肾形态学变化的影响。结果发现60min肾缺血后再灌流24hr,动物的Scr水平明显高于单纯缺血组动物的水平(P<0.01)和假手术组动物的水平(P<0.01);光镜下肾组织损伤较单纯缺血组动物明显加重,表明再灌流可以加重缺血肾损伤,动物发生缺血性急性肾衰(IARF)。给AP和SOD处理后,肾衰动物的Scr水平、肾系数分别较单纯再灌流组动物明显降低(P<0.01)。整个肾组织病变尤其是线粒体病变、刷状缘损伤大为减轻。说明AP和SOD可以减轻IARF,自由基可能参于肾缺血再灌流损伤,膜和线粒体损伤可能是IARF发病的重要因素。     

Therapeutic potential of ethyl acetate fraction of Tephrosia purpurea Linn. leaves in a rat model of gout

ObjectiveThe present study is to determine the potential treatment effects of ethyl acetate fraction of Tephrosia purpurea Linn. leaves (EATP) against gout.MethodsGout in experimental rats was induced with potassium oxonate at the dose of 250 mg/kg (intraperitoneal injection) for 7 consecutive days; EATP was administered 1 h after administration of the potassium oxonate on each day of experiment. Potassium oxonate was discontinued on the 8th day; thereafter allopurinol (10 mg/kg, p.o.) and EATP (200 and 400 mg/kg, p.o.) were continued until day 14. The uric acid level was measured from serum and urine during the experiment. Other biochemical parameters were assessed, including blood and urine creatinine, erythrocyte sedimentation rate, and total protein. Blood urea nitrogen, serum aspartate aminotransferase serum alanine aminotransferase and alkaline phosphatase were also measured. The blood was analyzed for levels of malondialdehyde and the antioxidant enzymes such as superoxide dismutase, catalase and glutathione peroxidase. Histopathological and radiological changes in the ankle of rats were observed after completion of the experiment.ResultsEATP was able to decrease serum uric acid and creatinine level; it also reduced inflammation, oxidative stress and lysosomal enzyme level, which has a role in acute inflammation. EATP increased uric acid excretion through urine due to its uricosuric effect.ConclusionEATP lowered the serum uric acid level and increased the urine uric acid level through excretion, which is useful in the treatment of gout. Hence the EATP was found to be helpful in the treatment of gout.     

药物超敏反应综合征45例临床特点分析

目的:总结药物超敏反应综合征的临床特点,比较欧洲、日本和中国诊断标准的差异。方法:收集陆军军医大学西南医院2009年1月至2019年1月确诊的45例药物超敏反应综合征,均根据Bocquet提出的标准诊断。回顾45例患者的病历资料,总结临床特点,分别采用欧洲标准、日本标准和中国标准重新评判,比较患者在潜伏期、皮疹消退时间...     

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...     

IgA肾病合并高尿酸血症患者的治疗及预后观察

目的：观察碳酸氢钠和别嘌呤醇结合泼尼松治疗IgA肾病合并高尿酸血症患者的临床效果及预后。方法：选取我科收治的60例IgA肾病合并高尿酸血症患者,分为两组,对照组予以泼尼松治疗,观察组在泼尼松治疗基础上加用碳酸氢钠1.5g/d和别嘌呤醇0.1g,对比两组患者治疗8周前后的血肌酐（Scr）、血尿酸（UA）、24h尿蛋白定量、肾小球滤过率（GFR）、总胆固醇（TC）和低密度脂蛋白（LDL）。结果：组内比较：两组患者治疗8周后血尿酸、总胆固醇和低密度脂蛋白水平均显著低于治疗前,而GFR高于治疗前,差异具有统计学意义（P均〈0.05）;组间比较：观察组治疗8周后Scr、UA、24h尿蛋白定量、TC和LDL低于对照组,GFR高于对照组,差异具有统计学意义（P均〈0.01）。结论：碳酸氢钠和别嘌呤醇结合泼尼松治疗IgA肾病合并高尿酸血症患者,能显著降低患者的血肌酐和血尿酸,改善蛋白尿情况和肾小球滤过率,同时降低患者血脂水平,从而改善患者预后和生活质量。