质子泵抑制剂诱发痛风性关节炎急性发作病例回顾并可能机制分析

Acute gouty arthritis induced by proton pump inhibitors: Clinical characteristics and possible mechanisms

目的分析质子泵抑制剂(proton pump inhibitor,PPI)诱发患者痛风性关节炎急性发作的病例资料,并探讨其可能的机制.方法收集2009-09/2016-11天津医科大学总医院的8例PPI致痛风性关节炎复发患者的资料,并作进一步分析.结果共收集PPI致痛风性关节炎复发的患者8例,均为男性,初诊断为消化性溃疡(75.0%)或糜烂性胃炎(25.0%),伴高尿酸血症,且尿pH≤6,用药起始至发作的平均时间为6.67 d,临床表现以单关节或多关节红、肿、疼痛和活动受限为主,多伴发热(62.5%).实验室检查主要为用药后白细胞计数、中性粒细胞百分比升高及尿酸升高(75.0%),肌酐及尿素氮降低(87.5%),血清K+降低(P<0.05),Na^+、Cl^-升高(62.5%).停药、对症治疗、非甾体类抗炎药物或激素通常可以缓解.结论 P P I引起患者痛风性关节炎的复发,可能是某些情况下质子泵抑制剂抑制肾脏H^+-K^+-ATP酶或血容量减少的结果 .

AIM To analyze the clinical characteristics and possible mechanisms of acute gouty arthritis induced by proton pump inhibitors（PPIs）.METHODS Clinical data for patients with refractory gout after treatment with PPIs from July 2009 to November 2016 in Tianjin Medical University General Hospital were retrospectively analyzed.Eight cases with acute gouty arthritis without usage of diuretics were enrolled for further analysis.RESULTS Eight male patients with acute gouty arthritis after treatment with PPIs were initially diagnosed with peptic ulcer（75.0%） or erosive gastritis（25.0%）,accompanied by hyperuricemia and urine pH equal to or less than 6.Mean time from PPI prescription to arthritis onset was 6.67 days.Acute gout led to redness,swelling,pain and limited function in the damaged single joint or several joints,which was often accompanied by fever（62.5%）.According to laboratory examinations,leukocyte count,percentage of neutrophils,and serum uric acid increased in6（75%） patients,while decreased creatinine and urea were found in 7（87.5%） patients after treatment with PPIs.Serum K~＋ concentrations decreased（P 〈 0.05） in all the 8 patients,while serum Na~＋ and Cl^-concentrations increased in5（62.5%） patients.Pain may be relieved after withdrawal of PPIs,symptomatic treatment,or treatment with nonsteroidal anti-inflammatory drugs or steroids.CONCLUSION PPIs can sometimes induce refractory gout,which may result from inhibitory effects of PPIs on H~＋-K~＋-ATPase existing in the kidneys or from the reduction of blood volume.