甲泼尼龙片对伴轻、中度酒精性肝损伤急性痛风性关节炎的疗效与安全性
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摘要
目的探讨甲泼尼龙片对伴轻、中度酒精性肝损伤时的急性痛风性关节炎的疗效与安全性。方法选取2015年8月至2017年10月深圳市龙华区人民医院风湿免疫科收治的符合入选标准的67例痛风患者作为研究对象,所有患者均使用甲泼尼龙片治疗,详细记录疗效及发生的不良反应。结果患者自己进行评估的受累关节疼痛程度在服药治疗前为(3.2±0.4)分,在治疗第1天后为(1.5±0.5)分,在治疗第7天时为(0.1±0.3)分,关节疼痛接近完全缓解,治疗后分别与治疗前比较差异均有统计学意义(P<0.05);研究者评估的受累关节疼痛程度在服药治疗前为(3.2±0.4)分,在服药治疗的第2天为(0.9±0.5)分,在服药治疗的第7天为(0.1±0.3)分,分别与治疗前比较差异均有统计学意义(P<0.05);与治疗前比较,研究者评估的受累关节的皮肤发红程度[(2±0)分vs(1.5±0.7)分]、关节压痛程度[(2.8±0.3)分vs(0.7±0.5)分]及关节肿胀程度[(2.1±0.3)分vs(0.9±0.3)分]在服药7 d后均有显著减轻,差异均有统计学意义(P<0.05);痛风患者及研究者对治疗的整体疗效评估结果均提示甲泼尼龙片对急性痛风性关节炎的有效率达100.0%,超过63.0%的患者在治疗后完全缓解。仅有3例(4.23%)痛风患者在服药过程中出现恶心,有3例(4.23%)痛风患者在服药过程中出现轻微腹痛,上述症状均可迅速缓解;痛风患者肝功能在治疗结束后有显著改善,但丙氨酸氨基转移酶仍未完全自行恢复正常。结论甲泼尼龙片对伴轻、中度酒精性肝损伤的急性痛风性关节炎疗效迅速、肯定,安全性较好,不会加重痛风患者已有的肝功能损害。
Objective To evaluate the efficacy and safety of oral methylprednisolon in the treatment of acute gout arthritis complicating mild-to-moderate alcoholic liver injuries. Methods A total of 67 patients with acute gout arthritis complicating mild-to-moderate alcoholic liver injuries meeting the inclusion criteria, who admitted to Department of Rheumatology in People's Hospital of Longhua New District of Shenzhen from August 2015 to October 2017, were collected as research objects. These patients were treated for 7 days with oral methylprednisolon 24 mg per day. The primary efficacy end point was the patient's assessment of pain in the involved joint over days 1-7. Safety was assessed by adverse experiences occurring during the treatment. Results The patient's assessment of joint pain was(3.2±0.4) before treatment, and decreased to(1.5±0.5) on day 1,(0.1±0.3) on day 7(P<0.05). The investigator's assessment of joint pain was(3.2±0.4) before treatment, and decreased to(0.9±0.5) on day 2 and(0.1±0.3) on day 7(P<0.05). Oral methylprednisolon were effective in improving swell(2.1±0.3) vs(0.9±0.3), tenderness(2.8±0.3) vs(0.7±0.5), erythema(2±0) vs(1.5±0.7)(P<0.05), and had a very low incidence of drug-related side effects, with only 3 patients(4.23%) having a short experience of nausea and 3 patients(4.23%) of slightly abdominal pain. Patient's and investigator's global assessments of response to therapy both indicated that the efficacy of oral methylprednisolon was very good(63.0% of the patients got complete remission, and the effective rate was 100.0%). Conclusion Oral methylprednisolone is an effective treatment for acute gout arthritis complicating mild-to-moderate alcoholic liver injuries, and it was generally safe and well tolerated.
Objective To evaluate the efficacy and safety of oral methylprednisolon in the treatment of acute gout arthritis complicating mild-to-moderate alcoholic liver injuries. Methods A total of 67 patients with acute gout arthritis complicating mild-to-moderate alcoholic liver injuries meeting the inclusion criteria, who admitted to Department of Rheumatology in People's Hospital of Longhua New District of Shenzhen from August 2015 to October 2017, were collected as research objects. These patients were treated for 7 days with oral methylprednisolon 24 mg per day. The primary efficacy end point was the patient's assessment of pain in the involved joint over days 1-7. Safety was assessed by adverse experiences occurring during the treatment. Results The patient's assessment of joint pain was(3.2±0.4) before treatment, and decreased to(1.5±0.5) on day 1,(0.1±0.3) on day 7(P<0.05). The investigator's assessment of joint pain was(3.2±0.4) before treatment, and decreased to(0.9±0.5) on day 2 and(0.1±0.3) on day 7(P<0.05). Oral methylprednisolon were effective in improving swell(2.1±0.3) vs(0.9±0.3), tenderness(2.8±0.3) vs(0.7±0.5), erythema(2±0) vs(1.5±0.7)(P<0.05), and had a very low incidence of drug-related side effects, with only 3 patients(4.23%) having a short experience of nausea and 3 patients(4.23%) of slightly abdominal pain. Patient's and investigator's global assessments of response to therapy both indicated that the efficacy of oral methylprednisolon was very good(63.0% of the patients got complete remission, and the effective rate was 100.0%). Conclusion Oral methylprednisolone is an effective treatment for acute gout arthritis complicating mild-to-moderate alcoholic liver injuries, and it was generally safe and well tolerated.
引文
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[9]Sivera F,Andres M,Carmona L,et al.Multinational evidencebased recommendations for the diagnosis and management of gout:integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative[J].Ann Rheum Dis,2014,73(2):328-335.
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[11]曾小峰,陈耀龙.2016中国痛风诊疗指南[S].浙江医学,2017,39(21):1823-1832.
[12]Dalbeth N,Stamp L,Merriman T.Gout[J].Lancet,2016,388(10):2039-2052.
[13]Engel B,Just J,Bleckwenn M,et al.Treatment options for gout[J].Dtsch Arztebl Int,2017,114(13):215-222.
[2]van Durme C,van Echteld IA,Falzon L,et al.Cardiovascular risk factors and comorbidities in patients with hyperuricemia and/or gout:a systematic review of the literature[J].J Rheumatol Suppl,2014,92(9):9-14.
[3]Rubin BR,Burton R,Navarra S,et al.Efficacy and safety profile of treatment with etoricoxib 120 mg once daily compared with indomethacin 50 mg three times daily in acute gout[J].Arthritis&Rheumatism,2010,50(2):598-606.
[4]Xu L,Liu S,Guan M,et al.Comparison of prednisolone,etoricoxib,and indomethacin in treatment of acute gouty arthritis:an open-label,randomized,controlled trial[J].Med Sci Monit,2016,22(3):810-817.··
[5]Smith HS,Bracken D,Smith JM.Gout:current insights and future perspectives[J].Journal of Pain,2011,12(11):1113-1129.
[6]Jordan KM,Cameron JS,Snaith M,et al.British society for rheumatology and british health professionals in rheumatology guideline for the management of gout[J].Rheumatology(Oxford),2007,46(8):1372-1374.
[7]Khanna D,Khanna PP,Fitzgerald JD,et al.2012 American college of rheumatology guidelines for management of gout.part 1:systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia[J].Arthritis Care Res(Hoboken),2012,64(10):1431-1446.
[8]Khanna D,Khanna PP,Fitzgerald JD,et al.2012 American college of rheumatology guidelines for management of gout.part 2:therapy and anti-inflammatory prophylaxis of acute gouty arthritis[J].Arthritis Care Res(Hoboken),2012,64(10):1447-1461.··
[9]Sivera F,Andres M,Carmona L,et al.Multinational evidencebased recommendations for the diagnosis and management of gout:integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative[J].Ann Rheum Dis,2014,73(2):328-335.
[10]Richette P,Doherty M,Pascual E,et al.2016 updated EULAR evidence-based recommendations for the management of gout[J].Ann Rheum Dis,2017,76(1):29-42.
[11]曾小峰,陈耀龙.2016中国痛风诊疗指南[S].浙江医学,2017,39(21):1823-1832.
[12]Dalbeth N,Stamp L,Merriman T.Gout[J].Lancet,2016,388(10):2039-2052.
[13]Engel B,Just J,Bleckwenn M,et al.Treatment options for gout[J].Dtsch Arztebl Int,2017,114(13):215-222.