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目的探讨难治性痛风关节炎的临床特点。方法分析17例难治性痛风性关节炎患者的临床资料,与同期就诊的普通痛风性关节炎患者资料进行比较(等距抽样)。结果本组17例难治性痛风组患者均为多关节受累(100%),与普通痛风患者比较P<0.05,差异有统计学意义;难治性痛风组患者病程(5.31±1.82)年与普通痛风患者(1.63±0.74)年比较P<0.05,差异有统计学意义。17例难治性痛风组患者15例合并代谢综合征(88.2%)与40例普通痛风患者21例合并代谢综合征(52.5%)比较P<0.05,差异有统计学意义。难治性痛风组患者总胆固醇水平为(4.91±1.25)mmol/L与普通痛风患者(4.29±2.30)mmol/L比较P<0.05,差异有统计学意义。难治性痛风组患者尿酸值为(551.34±123.48)mmol/L与普通痛风患者(524.92±33.77)mmol/L比较P<0.05,差异有统计学意义。使用药物治疗后,难治性痛风患者的疼痛持续时间为(14.15±24.83)天,与普通痛风患者(9.28±17.80)天比较P<0.05,差异有统计学意义。急性期治疗后,难治性痛风组VAS评分(4.73±1.24)分与普通痛风患者(3.27±0.72)分比较P<0.05,差异有统计学意义。结论难治性痛风病程较长,受累关节多,更易合并代谢综合征,尤其是合并总胆固醇代谢异常,难治性痛风患者的尿酸值明显高于普通痛风患者,但难治性痛风尿酸排泄率与普通痛风比较差异无统计学意义,两者在急性发作时均可通过药物缓解,但相比普通痛风患者,药物对难治性痛风疗效较差,且治疗后疼痛持续时间长。
Objective To investigate the clinical features of refractory gouty arthritis. Methods Clinical data of 17 patients with refractory gouty arthritis were analyzed and compared with those of patients with common gouty arthritis (isometric sampling). Results The 17 patients with refractory gout group had multiarticular involvement (100%), which was significantly lower than that of the common gout group (P <0.05), and the difference was statistically significant. The duration of the refractory gout group was 5.31 ± 1.82 years The average gout patients (1.63 ± 0.74) years P <0.05, the difference was statistically significant. There were statistically significant differences between 15 patients with metabolic syndrome (88.2%) and 21 patients with metabolic syndrome (52.5%) in 17 patients with refractory gout, P <0.05. The total cholesterol level in refractory gout group was (4.91 ± 1.25) mmol / L compared with 4.49 ± 2.30 mmol / L in normal gout group (P <0.05), and the difference was statistically significant. The uric acid value in the refractory gout group was (551.34 ± 123.48) mmol / L compared with that in the general gout group (524.92 ± 33.77) mmol / L, P <0.05, the difference was statistically significant. The pain duration of patients with refractory gout was (14.15 ± 24.83) days after treatment with drug, and P <0.05 compared with that of normal gout (9.28 ± 17.80), the difference was statistically significant. After acute phase, the VAS score (4.73 ± 1.24) in patients with refractory gout was significantly lower than that in patients with general gout (3.27 ± 0.72), P <0.05, the difference was statistically significant. Conclusions The course of refractory gout is longer, involving more joints and more likely to be associated with metabolic syndrome. In particular, patients with refractory gout have significantly higher uric acid levels than those with general gout. However, uric acid excretion rate Compared with normal gout, there was no significant difference between the two groups. Both of them can be relieved by drugs in acute attack. However, compared with common gout patients, the drug has poor curative effect on refractory gout and prolonged pain after treatment.