老年痛风的临床特点和治疗

目的探讨老年痛风的发病机理、临床特点和治疗方法。方法60岁以上痛风性关节炎患者138例。分析尿酸代谢情况，合并症及治疗效果。结果单关节受累62例(占44.9％)，多关节受累76例(占55.1％)。有肾结石者17例(占12.3％)，痛风石19例(占13.8％)。主要合并症为高血压病、冠心病、高脂血症和糖尿病。用苯溴马龙治疗后，症状好转，血清尿酸下降到正常〔治疗前(540.6±112.8)μmol/L，治疗后(252.0±73.2)μmol/L，P＜0.01〕，肾脏清除尿酸分数增加〔(6.6±3.7)％，(14.4±8.2)％，P＜0.01〕，内生肌酐清除率无明显变化。结论本文结果表明，本病的发病机理是肾脏清除尿酸能力下降，使用增加肾脏清除尿酸的药物有效。

Gout in the Elderly: the Clinical Manifestation and Treatment

Objective:To investigate the pathogenesis, clinical manifestation, and treatment of gout in the elderly. Methods: One hundred and thirty-eight primary gout patients were observed. All of them were over 60 years. The metabolism of uric acid, complication and the curative effect were analyzed. Results: Single-joint-arthritis was found in 44.9% patients and poly-joint-arthritis was 55.1 % . Four major complications were found which included primary hypertension, coronary heart disease, hyperlipdemia, and diabetes. After treatment with Benzbromarone, the arthritis disappeared and the serum urate acid decreased to normal [from (540.6?112.8) jmnol/L to (252.0?3.2) nmol/L, P<0.01]. The FRUAC increased from(6.6?.7)% to (14.4 ?8.2)% (P<0.01). The change of Cr was not significant. Conclusion: The important pathogenesis of gout in the elderly is the inability of renal clearance under high urate acid load. Benzbromarone is an effective drug to treat gout in the elderly.