血尿酸持续达标治疗在难治性痛风中的意义

Significance of continuous standard treatment of blood uric acid in patients with primary intractable gout

摘要:

目的为促进难治性痛风患者血尿酸持续达标治疗的有效实施，引起患者及医护人员对血尿酸持续达标治疗的重视，形成规范化的治疗和管理措施提供科学依据。方法选取2013 年6 月-2015 年6 月海南省人民医院肾病风湿科住院的原发性难治性痛风患者92 例为研究对象，对患者进行1 年的治疗及随访，记录其治疗实施情况和疾病控制情况。结果在过去的1 年中，有39 例患者坚持实施了规范化血尿酸持续达标治疗，患者依从率为42.4%；经过1 年的治疗，坚持血尿酸持续达标治疗的患者痛风发作频率较治疗前降低（z =-3.020， p=0.003），受累关节数有所减少（z =-2.453，p =0.014），痛风石体积缩小了（χ2=5.786，p =0.013），有并发症的患者人数也明显减少（χ2=4.083，p =0.039）；1 年后，坚持“血尿酸持续达标治疗”的患者痛风发作频率（z =2.915，p =0.004）、受累关节数（z =2.881， p=0.004）、痛风石体积缩小率（χ2=6.321，p =0.012）均少于未坚持血尿酸持续达标治疗的患者。结论血尿酸持续达标治疗可有效降低痛风发作频率、减少受累关节数、缩小痛风石体积和减少并发症的发生，今后需通过加强健康宣教、建立患者的随访档案、及时监督患者复查、规范痛风的非药物和药物治疗和关注并发症，以推动血尿酸持续达标规范化治疗更好地实施。

Abstract:

Objective To implement the continuous standard treatment of blood uric acid in patients with primary and intractable gout, in order to draw attention of the patients and health care workers to this treatment, and provide scientific basis for the standardization of treatment and management measures. Methods Ninety-two patients with primary refractory gout in the Department of Rheumatic Immunology in our hospital from June 2013 to June 2015 were chosen. They were followed up for 1 year, and the treatment and disease control were recorded. Results In the past 1 year, 39 patients (42.4%) adhered to the continuous standard treatment of blood uric acid, the frequency of gout attack (p < 0.05) and the number of affected joints (p < 0.05) were significantly reduced, most tophi were nar-rowed (p < 0.05), and the number of the patients with complications were significantly reduced (p < 0.05). After one year of treatment, the frequency of gout attack (p < 0.05), the number of affected joints (p < 0.05) and the reduction rate of tophus volume (p < 0.05) were significantly decreased in the patients who adhered to the continuous standard treatment of blood uric acid compared to the patients who did not. Conclusions The continuous standard treatment of blood uric acid can effectively reduce the frequency of gout attack, the number of affected joints, the volume of tophi and the incidences of complications; hence we need to strengthen the health education, establish the patients' follow-up files and timely supervise the patients to review, standardize the drug and non-drug therapies for gout, and pay attention to complications, so as to promote better implementation of the continuous standard treatment of blood uric acid.