无肝素血液碳酸液透析治疗痛风性肾病合并别嘌醇过敏综合征一例

Treatment of gouty nephropathy complicated with allopurinol hypersensitivity syndrome by bicarbonate hemodialysis: a case report

中国汉族人由于HLA-B*58∶01阳性率高,易发生别嘌醇过敏综合征。该文报道了一例82岁男性痛风性肾病合并别嘌醇过敏综合征患者,该例患者反复出现跖趾关节疼痛及血清尿酸升高10余年,近1年痛风发作次数增多,抗炎治疗效果欠佳,当地医院门诊予别嘌醇治疗7 d后出现全身剥脱性皮炎,急诊收入院后发现慢性肾衰竭(慢性肾脏病4期)、肝功能受损,常规的黄嘌呤氧化酶抑制剂和促进尿酸排泄药物均不能使用。入院后予足量肾上腺皮质激素静脉滴注,积极无肝素血液碳酸液透析、抗感染等治疗后,患者痛风发作疼痛缓解,血清尿酸水平下降,皮肤皮损愈合,肝功能恢复。该例诊治提示,中国汉族人在服用别嘌醇降尿酸时检测HLA-B*58∶01非常重要,对于合并肝、肾功能损伤者不能使用促进尿酸排泄药物,血液碳酸液透析是有效、安全的治疗方式。

The Han Chinese are susceptible to allopurinol hypersensitivity syndrome due to high posi- tive rate of HLA-B ＊ 58： 01. The article reported an 82-year-old male patient diagnosed with gouty nephropathy complicated with allopurinol hypersensitivity syndrome. He suffered from recurrent metatarsophalangeal joint pain and hyperurieemia for over 10 years. In recent 1 year, the episode of gout became more and more frequent and was untreated with anti-inflammatory therapy. He presented with oxfoliative dermatitis at 7 days after allo- purinol administration in a local hospital. Upon admission to our hospital, he was diagnosed with chronic kid- ney disease （CKD 4） and hepatic function injury. Conventional xanthine oxidase inhibitors （XOI） or uricosu- ric drugs were prohibited. After hospitalization, he was administered with an adequate dose of adrenocortical hormone via intravenous route. Following active bicarbonate hemodialysis and anti-infection therapy, gout symptoms were alleviated, serum uric acid level was decreased, skin lesions were healed and liver function re- stored to normal. The diagnosis and treatment of this case hint that it is necessary to conduct screening of posi- tive HLA-B ＊ 58：01 in the Han population when administered with allopurinol. Bicarbonate hemodialysis is an effective and safe treatment for patients who are complicated with liver and/or renal function injuries, and un- suitable for use of uricosurie drugs.