泼尼松联合应用碳酸氢钠治疗痛风合并慢性肾功能不全的疗效
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摘要
目的探讨泼尼松联合应用碳酸氢钠治疗痛风合并慢性肾功能不全的疗效。方法145例痛风合并慢性肾功能不全患者在基础治疗的基础上,B组72例单用口服泼尼松30mg,每日1次;A组73例加用5%碳酸氢钠120ml加入5%葡萄糖400ml静脉输注,每日1次。检测治疗前和治疗1周后的肾功能、肝功能和血脂等相关指标,比较两组疗效和WOMAC骨关节炎指数评分。结果与B组比较,A组治疗总有效率升高(95.9%vs.80.6%)(P<0.05)。治疗1周后,两组相关生化指标均较治疗前改善(P<0.05),A组的血尿酸、SCr和胱抑素C、肾小球滤过率、ALT、AST、TG和LDL-C以及血沉和C-反应蛋白水平均优于B组(P<0.05)。治疗1周后,两组患者关节肿痛和WOMAC骨关节炎指数评分均较治疗前下降(P<0.05),A组下降较B组明显(P<0.05)。结论与单用口服泼尼松比较,加用等渗碳酸氢钠输注治疗痛风合并慢性肾功能不全的临床疗效更好。
Objective To observe clinical efficacy of combined use of prednisone and sodium hydrogencarbonate in treating gout complicated with chronic renal insufficiency.Methods A total of145 patients with gout complicated with chronic renal insufficiency was assigned into two groups of A(73 cases)and B(72 cases).On the basis of therapeutic regimes,group B was treated with oral prednisone 30 mg,daily for seven days.Group A was treated with additional infusion of 5% sodium hydrogencarbonate 120 ml in 5% glucose 400 ml,daily for seven days.The relevant indicators of renal function,liver function and blood lipids were determined before and one week after treatment.Clinical efficacy and WOMAC score were compared between two groups.Results Compared to group B,the overall effectiveness rate was significantly higher in group A(95.9% vs.80.6%)(P<0.05).The biochemical indicators of two groups were obviously improved one week after treatment than those before(P<0.05).The uric acid,serum creatinine,cystatin C,glomerular filtration rate,alanine aminotransferase,aspartate aminotransferase,triglyceride,low density lipoprotein cholesterol,erythrocyte sedimentation rate,and C-reactive protein one week after treatment were better in group A than those in group B(P<0.05).The scores of joint pain and WOMAC in two groups were lower one week after treatment than those before(P<0.05),which were significantly lower in group A than those in group B(P<0.05).Conclusion Clinical efficacy of prednisone combined with sodium hydrogencarbonate is better than prednisone alone in treating gout complicated with chronic renal insufficiency.
Objective To observe clinical efficacy of combined use of prednisone and sodium hydrogencarbonate in treating gout complicated with chronic renal insufficiency.Methods A total of145 patients with gout complicated with chronic renal insufficiency was assigned into two groups of A(73 cases)and B(72 cases).On the basis of therapeutic regimes,group B was treated with oral prednisone 30 mg,daily for seven days.Group A was treated with additional infusion of 5% sodium hydrogencarbonate 120 ml in 5% glucose 400 ml,daily for seven days.The relevant indicators of renal function,liver function and blood lipids were determined before and one week after treatment.Clinical efficacy and WOMAC score were compared between two groups.Results Compared to group B,the overall effectiveness rate was significantly higher in group A(95.9% vs.80.6%)(P<0.05).The biochemical indicators of two groups were obviously improved one week after treatment than those before(P<0.05).The uric acid,serum creatinine,cystatin C,glomerular filtration rate,alanine aminotransferase,aspartate aminotransferase,triglyceride,low density lipoprotein cholesterol,erythrocyte sedimentation rate,and C-reactive protein one week after treatment were better in group A than those in group B(P<0.05).The scores of joint pain and WOMAC in two groups were lower one week after treatment than those before(P<0.05),which were significantly lower in group A than those in group B(P<0.05).Conclusion Clinical efficacy of prednisone combined with sodium hydrogencarbonate is better than prednisone alone in treating gout complicated with chronic renal insufficiency.
引文
[1]高莹,张治然,汤志宏,等.苯溴马隆联合痛风定胶囊治疗痛风性关节炎的疗效观察[J].临床军医杂志,2015,43(10):1060-1062.
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[3]Frampton JE.Febuxostat:a review of its use in the treatment of hyperuricaemia in patients with gout[J].Drugs,2015,75(4):427-438.
[4]Khanna D,Khanna PP,Fitzgerald JD,et al.2012American College of Rheumatology guidelines for management of gout.Part 2:therapy and antiinflammatory prophylaxis of acute gouty arthritis[J].Arthritis Care Res(Hoboken),2012,64(10):1447-1461.
[5]武东,赵金霞,孙琳,等.痛风炎症机制的研究进展[J].中华风湿病学杂志,2014,18(2):128-130.
[6]Tsuruta Y,Mochizuki T,Moriyama T,et al.Switching from allopurinol to febuxostat for the treatment of hyperuricemia and renal function in patients with chronic kidney disease[J].Clin Rheumatol,2014,33(11):1643-1648.
[7]Kataoka H,Yang K,Rock KL.The xanthine oxidase inhibitor Febuxostat reduces tissue uric acid content and inhibits injury induced inflammation in the liver and lung[J].Eur J Pharmacol,2015,746:174-179.
[8]Janssens HJ,Janssen M,van de Lisdonk EH,et al.Use of oral prednisolone or naproxen for the treatment of gout arthritis:a double-blind,randomised equivalence trial[J].Lancet,2008,371(9627):1854-1860.
[9]中华医学会.临床诊疗指南风湿病分册[M].北京:人民卫生出版社,2005:123.
[10]中华医学会内分泌学分会.高尿酸血症和痛风治疗的中国专家共识[J].中华内分泌代谢杂志,2013,29(11):913-920.
[11]El-Zawawy H,Mandell BF.Managing gout:how is it different in patients with chronic kidney disease[J]?Cleve Clin J Med,2010,77(12):919-928.
[12]傅淑霞,李绍梅,于连英.2014年肾脏疾病临床进展[J].临床荟萃,2015,30(2):161-166.
[13]吴晓蓉,张开凯,杨雷,等.原发性痛风肾功能损害影响因素分析[J].江苏医药,2015,41(24):3039-3040.
[14]刘方,张慧,蒋易容.IgA肾病合并高尿酸血症患者的治疗及预后观察[J].海南医学院学报,2014,20(1):77-79.
[15]刘擘,徐安平,曾玉纯,等.血尿酸水平与IgA肾病临床及病理的关系[J].广东医学,2015,36(13):2068-2070.
[16]Curiel RV,Guzman NJ.Challenges associated with the management of gouty arthritis in patients with chronic kidney disease:a systematic review[J].Semin Anhritis Rheum,2012,42(2):166-178.
[17]Schumacher HR Jr,Sundy JS,Terkeltaub R,et al.Rilonacept(interleukin-1trap)in the prevention of acute gout flares during initiation of urate-lowering therapy:results of a phaseⅡrandomized,double-blind,placebo-controlled trial[J].Arthritis Rheum,2014,64(3):876-884.
[18]寇俊梓,李钊.加味萆薢分清饮治疗痛风性关节炎临床研究[J].辽宁中医药大学学报,2014,16(3):171-172.
[19]庄丽华,胡家才,吴昊.中西医结合治疗急性痛风性关节炎疗效观察[J].微循环学杂志,2014,24(3):18-20.
[20]王玉龙,扈佐鸿,刘道碧,等.5%碳酸氢钠溶液关节镜下冲洗治疗痛风性膝关节炎[J].东南国防医药,2014,16(2):197-198,217.
[21]胡永勤,吴坚.血清胱抑素C和尿微量白蛋白与肌酐比值对痛风患者早期肾功能损伤的诊断价值[J].医学临床研究,2013,30(2):282-284.
[2]Tayar JH,Lopez-Olivo MA,Suarez-Almazor ME.Febuxostat for treating chronic gout[J].Cochrane Dambase Syst Rev,2012,11:CD008653.
[3]Frampton JE.Febuxostat:a review of its use in the treatment of hyperuricaemia in patients with gout[J].Drugs,2015,75(4):427-438.
[4]Khanna D,Khanna PP,Fitzgerald JD,et al.2012American College of Rheumatology guidelines for management of gout.Part 2:therapy and antiinflammatory prophylaxis of acute gouty arthritis[J].Arthritis Care Res(Hoboken),2012,64(10):1447-1461.
[5]武东,赵金霞,孙琳,等.痛风炎症机制的研究进展[J].中华风湿病学杂志,2014,18(2):128-130.
[6]Tsuruta Y,Mochizuki T,Moriyama T,et al.Switching from allopurinol to febuxostat for the treatment of hyperuricemia and renal function in patients with chronic kidney disease[J].Clin Rheumatol,2014,33(11):1643-1648.
[7]Kataoka H,Yang K,Rock KL.The xanthine oxidase inhibitor Febuxostat reduces tissue uric acid content and inhibits injury induced inflammation in the liver and lung[J].Eur J Pharmacol,2015,746:174-179.
[8]Janssens HJ,Janssen M,van de Lisdonk EH,et al.Use of oral prednisolone or naproxen for the treatment of gout arthritis:a double-blind,randomised equivalence trial[J].Lancet,2008,371(9627):1854-1860.
[9]中华医学会.临床诊疗指南风湿病分册[M].北京:人民卫生出版社,2005:123.
[10]中华医学会内分泌学分会.高尿酸血症和痛风治疗的中国专家共识[J].中华内分泌代谢杂志,2013,29(11):913-920.
[11]El-Zawawy H,Mandell BF.Managing gout:how is it different in patients with chronic kidney disease[J]?Cleve Clin J Med,2010,77(12):919-928.
[12]傅淑霞,李绍梅,于连英.2014年肾脏疾病临床进展[J].临床荟萃,2015,30(2):161-166.
[13]吴晓蓉,张开凯,杨雷,等.原发性痛风肾功能损害影响因素分析[J].江苏医药,2015,41(24):3039-3040.
[14]刘方,张慧,蒋易容.IgA肾病合并高尿酸血症患者的治疗及预后观察[J].海南医学院学报,2014,20(1):77-79.
[15]刘擘,徐安平,曾玉纯,等.血尿酸水平与IgA肾病临床及病理的关系[J].广东医学,2015,36(13):2068-2070.
[16]Curiel RV,Guzman NJ.Challenges associated with the management of gouty arthritis in patients with chronic kidney disease:a systematic review[J].Semin Anhritis Rheum,2012,42(2):166-178.
[17]Schumacher HR Jr,Sundy JS,Terkeltaub R,et al.Rilonacept(interleukin-1trap)in the prevention of acute gout flares during initiation of urate-lowering therapy:results of a phaseⅡrandomized,double-blind,placebo-controlled trial[J].Arthritis Rheum,2014,64(3):876-884.
[18]寇俊梓,李钊.加味萆薢分清饮治疗痛风性关节炎临床研究[J].辽宁中医药大学学报,2014,16(3):171-172.
[19]庄丽华,胡家才,吴昊.中西医结合治疗急性痛风性关节炎疗效观察[J].微循环学杂志,2014,24(3):18-20.
[20]王玉龙,扈佐鸿,刘道碧,等.5%碳酸氢钠溶液关节镜下冲洗治疗痛风性膝关节炎[J].东南国防医药,2014,16(2):197-198,217.
[21]胡永勤,吴坚.血清胱抑素C和尿微量白蛋白与肌酐比值对痛风患者早期肾功能损伤的诊断价值[J].医学临床研究,2013,30(2):282-284.