关节痛风石取出手术对痛风患者血尿酸水平的影响

目的 探究不同部位痛风结石手术取出后对于痛风患者血尿酸水平的影响.方法 2014年5月至2016年5月云南省中医医院骨伤科住院部采用痛风石取出术治疗各关节痛风性结石符合纳入标准及完成后期随访患者72例, 根据手术部位及最多取石部位分为膝关节组 (35例) 和其他关节组 (37例) ;2组术前, 术后2周、8周行血尿酸检查;应用两样本t检验分析各组术前血尿酸 (s UA) 水平的差异, 并探究血尿酸 (s UA) 水平与痛风石发病部位的关联性;同时在术后2周、8周后复查各组患者的血尿酸水平, 应用配对样本t检验分析各组手术去除痛风石后对痛风患者近期 (2周) 及远期 (8周) 血尿酸水平的影响, 同时在2周、8周时对2组患者血尿酸水平进行对比.结果 (1) 术前1 d与其他关节组相比膝关节组血尿酸水平较高, 差异有统计学意义 (P<0.05) ;术后2周2组血尿酸水平差异无统计学意义 (P=0.0534) , 术后8周与其他关节组血尿酸水平相比膝关节组血尿酸水平明显处于较低水平, 差异有统计学意义 (P<0.01) ; (2) 术后2周、8周膝关节组血尿酸水平与术前1 d相比下降显著, 差异有统计学意义 (P<0.01) ;而术后2周其他关节组血尿酸水平与术前相比无明显变化 (P>0.05) , 术后8周其他关节组血尿酸水平与术前相比有所下降, 差异有统计学意义 (P<0.05) .结论 膝关节痛风结石应当进行早期彻底的清理和去除、有利于患者血尿酸水平的降低和保护膝关节;对于其他关节的痛风结石早期取石并不能逆转尿酸盐结晶的继续沉积, 而应当在尿酸盐沉积造成不可逆的关节结构损伤之前进行手术取出.

Effect of Taking-off Joint Gout Stone Operation on the Serum Uric Acid of Gout Patients

Objective To investigatethe the effect of taking-off gout stone in different body parts on the level of serum uric acid of gout patients through retrospective anlysis.Methods We selected 72 gout patients admitted to Yunnan TCM hospital to get rid of the joint gout stones by taking-off gout stone operation, met the inclusion criteria and comleted the follow-up.According to the operation location and the part with most gout stones, the enrolled patients were divided into 2 groups:35 cases in knee joint group (35cases) and 37 cases in other-joint group.Before operation, 2 weeks later and 3 weeks after operation, patients in the two groups received the serum uric acid tests.The two-sample T test was used to analyze the s UA difference between two groups before operation and the relationship between s UA level and gout stone location was investigated.The s UA levels of patients in two groups were retested 2 weeks and 8 weeks after operation, and the two-sample T test was used to analyze the short-term and long-term effect of operation on s UA levels, and compare the difference in the s UA level of patients between two groups at 2 weeks and 8 weeks after operation.Results (1) Compared with the other joint group, the s UA of knee joint group at 1 day before operation was relatively higher, and the difference had statisticalsignificance (P<0.05) .There was no significant difference in the s UA levels of patients 2 weeks after operation between two groups (P=0.0534) .Compared with the other joint group, the s UA of knee joint group at 8 weeks after operation was significantly lower, and the difference had statistical significance (P<0.05) . (2) Compared with 1 day before operation, the s UA level of patients in knee joint group at 2 weeks and 8 weeks after operation was significantly lower, and the difference had statistical significance (P<0.01) .There was no significant difference in the s UA levels of patients in other joint group between 2 weeks after operation adn 1 day before operation (P>0.05) .Compared with 1 day before operation, the s UA level of patients in other joint group at 8 weeks after operation was significantly lower, and the difference had statistical significance (P<0.01) .Conclusion For the gout stone in knee joint, taking off and getting rid of them might be necessary in lowering the s UA and protecting knee joint.However, for the gout stone in other joints, early taking off gout stone can't stop the redeposition of urate crystal, so it may be proper to take off the gout stone before the occurrence of irreversible joint injury.