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

Efficacy of combined use of prednisone and sodium hydrogencarbonate in treating gout complicated with chronic renal insufficiency

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.