痛风汤剂益肾养肝合剂治疗痛风性肾病33例临床观察

目的: 探讨痛风汤剂与益肾养肝合剂同用治疗痛风性肾病的临床疗效.方法: 将痛风性肾病患者58例分为两组,治疗组33例予痛风汤剂加益肾养肝合剂治疗,对照组25例只予痛风汤剂治疗.观察两组治疗前后血尿酸,肾功能,血、尿β2-微球蛋白指标的变化.结果: 治疗组在改善临床症状、肾功能,降低血尿酸、尿β2-微球蛋白(β2-MG)方面均优于对照组.结论: 对痛风性肾病患者的治疗,痛风汤剂与益肾养肝合剂同用扶正祛邪的治疗方法较好,能够改善肾小管功能.     

痛风丸治疗痛风的实验研究

目的：观察痛风丸对痛风性关节炎、高尿酸血症的影响及镇痛作用。方法：用尿酸钠致大鼠踝关节肿胀、酵母膏致小鼠高尿酸血症及小鼠冰醋酸所致的扭体反应，观察其抗痛风的作用。结果：痛风丸可明显减轻痛风模型大鼠的关节肿胀程度、降低高尿酸血症模型小鼠的血尿酸、减少扭体次数。结论：痛风丸对痛风的急性发作有一定的治疗作用。     

MRI对痛风性膝关节炎诊断的准确性研究

目的探讨MRI对痛风性膝关节炎诊断的准确性。方法回顾性分析张家港澳洋医院2015年7月至2019年2月收治的31例慢性痛风患者膝关节双能量CT和MRI检查图像,以双能量CT为金标准,检验MRI对痛风石检出的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果 4例患者行双侧膝关节双能量CT和MRI检查,共35个膝关节纳入研究。MRI对痛风石检出的特异性为0. 977(95%CI:0. 930～0. 994),敏感性为0. 648(95%CI:0. 551～0. 735),阳性预测值为96. 0%,阴性预测值为77. 0%,准确性为82. 8%。结论与双能量CT相比,MRI具有较高的特异性和准确性,对痛风性关节炎的诊断潜力较大。     

The inhibitor effect of RKIP on inflammasome activation and inflammasome-dependent diseases

Aberrant inflammasome activation contributes to the pathogenesis of various human diseases, including atherosclerosis, gout, and metabolic disorders. Elucidation of the underlying mechanism involved in the negative regulation of the inflammasome is important for developing new therapeutic targets for these diseases. Here, we showed that Raf kinase inhibitor protein (RKIP) negatively regulates the activation of the NLRP1, NLRP3, and NLRC4 inflammasomes. RKIP deficiency enhanced caspase-1 activation and IL-1β secretion via NLRP1, NLRP3, and NLRC4 inflammasome activation in primary macrophages. The overexpression of RKIP in THP-1 cells inhibited NLRP1, NLRP3, and NLRC4 inflammasome activation. RKIP-deficient mice showed increased sensitivity to Alum-induced peritonitis and Salmonella typhimurium-induced inflammation, indicating that RKIP inhibits NLRP3 and NLRC4 inflammasome activation in vivo. Mechanistically, RKIP directly binds to apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC) and competes with NLRP1, NLRP3, or NLRC4 to interact with ASC, thus interrupting inflammasome assembly and activation. The depletion of RKIP aggravated inflammasome-related diseases such as monosodium urate (MSU)-induced gouty arthritis and high-fat diet (HFD)-induced metabolic disorders. Furthermore, the expression of RKIP was substantially downregulated in patients with gouty arthritis or type 2 diabetes (T2D) compared to healthy controls. Collectively, our findings suggest that RKIP negatively regulates NLRP1, NLRP3, and NLRC4 inflammasome activation and is a potential therapeutic target for the treatment of inflammasome-related diseases.     

Tissue factor pathway inhibitor and thrombin-activatable carboxypeptidase B for prediction of early atherosclerosis in gouty arthritis

Background

Gouty arthritis (GA) is a chronic inflammatory arthritis in which both clinical and subclinical atherosclerosis are more frequent. The dynamic equilibrium between coagulation and fibrinolysis is impaired in inflammatory diseases. We determined TFPI and TAFI antigen levels in GA patients and evaluated their association with subclinical atherosclerosis.

Methods

We included 45 GA patients (41 males, 4 females; mean age: 51.6 years) and 25 asymptomatic hyperuricemic (AHU) subjects (19 males, 6 females; mean age: 48.1 years). Cardiovascular risk factors were determined. TAFI and TFPI levels were determined by ELISA. B-mode ultrasonography was used to detect subclinical atherosclerosis.

Results

Cardiovascular risk factors were similar in both groups. The carotid IMT was significantly higher in GA group than in AHU group (0.74 ± 0.23 mm vs. 0.61 ± 0.13 mm, p = 0.009). TFPI level was significantly higher in GA group than in AHU group (86.2 ± 48.9 ng/mL vs. 25.8 ± 21.4 ng/mL, p < 0.001); TAFI antigen was significantly higher in AHU group (22.6 ± 3.6 ng/mL vs. 25.7 ± 5.3 ng/mL, p = 0.006) than in GA patients. Atherosclerotic plaque formation was more frequent in GA group (p = 0.041). When GA patients with and without plaques were compared, the first group had significantly higher mean age (p = 0.01) and TFPI level (p = 0.028). TFPI level correlated with carotid IMT (r = 0.302; p = 0.028). Logistic regression analysis showed that age (OR: 1.236, 95%CI: 1.059-1.443, p = 0.007) and TFPI (OR: 1.031, 95%CI: 1.008-1.054, p = 0.008) were independent risk factors for the presence of plaques.

Conclusions

GA patients had more frequent subclinical atherosclerosis than subjects with AHU. Higher TFPI levels in GA patients –probably associated with enhanced endothelial damage- were related to subclinical atherosclerosis. Lower TAFI levels in GA pointed to impaired fibrinolysis.     

Current Concepts in the Treatment of Gouty Arthritis

Gouty arthritis is an extremely painful condition that causes functional impairment. Gouty arthritis has become increasingly complex because of multiple comorbidities, iatrogenic factors and hyperuricemia that is refractory to treatment. In this review, we present a general overview of gouty arthritis including its pathophysiology, clinical presentations, diagnosis, predisposing factors and prophylactic therapy for preventing gouty arthritis flares.     

中药对高尿酸血症患者肠道菌群影响的研究进展

高尿酸血症是痛风发病的重要病理基础,可引发痛风性关节炎、痛风石、痛风性肾病,引起关节破坏、肾功能损伤等并发症。人体内约1/3的尿酸通过肠道代谢,近年来研究发现肠道菌群与高尿酸血症密切相关。中药在降尿酸方面具有显著的疗效性和良好的安全性,可能与肠道菌群的调节有关。运用转录组学、代谢组学及宏基因组学等测序技术分析口服中药后肠道微生物多样性、种群结构及基因表达的变化,阐述中药与肠道菌群的相互作用机制是目前研究的重要方向。本综述总结了该领域最新研究进展,展望了未来的研究趋势。     

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.     

护理干预对痛风性关节炎患者遵医行为及治疗效果的影响分析

目的：探讨护理干预对痛风性关节炎患者遵医行为及治疗效果的影响分析。方法：选取2012年1月-2013年10月本科收治的50例痛风性关节炎患者,按照随机数字表法将其分为对照组和干预组各25例,对照组采用常规护理方法,干预组根据患者遵医行为等进行重点护理干预,观察比较两组患者护理干预前后的遵医行为变化情况及临床治疗效果。结果：对照组干预前后各项遵医行为比较差异均无统计学意义（P〉0．05）,而干预组经护理干预后,其心理状况、生活方式及治疗依从性均达到60分以上,与干预前及对照组比较差异均有统计学意义（P〈0．05）。且干预组的治疗总有效率92．0％明显高于对照组64．0％,差异有统计学意义（P〈0．05）。结论：加强综合性护理干预能够明显改善痛风性关节炎患者的遵医行为,明显提升患者的治疗效果,对提高患者的生活质量和改善预后具有重要意义。     

MRI对痛风性膝关节炎诊断的准确性研究

目的 探讨MRI对痛风性膝关节炎诊断的准确性。方法 回顾性分析张家港澳洋医院2015年7月至2019年2月收治的31例慢性痛风患者膝关节双能量CT和MRI检查图像,以双能量CT为金标准,检验MRI对痛风石检出的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果 4例患者行双侧膝关节双能量CT和MRI检查,共35个膝关节纳入研究。MRI对痛风石检出的特异性为0.977（95% CI：0.930~0.994）,敏感性为0.648（95% CI：0.551~0.735）,阳性预测值为96.0%,阴性预测值为77.0%,准确性为82.8%。结论 与双能量CT相比,MRI具有较高的特异性和准确性,对痛风性关节炎的诊断潜力较大。