抗结核药物和继发性高尿酸血症及痛风临床探讨

Clinical study of antituberculosis drugs secondary hyperuricemia and gout

目的研究初治肺结核病人在抗结核化疗前和强化治疗及停用吡嗪酰胺(PZA)后的血尿酸水平的变化,掌握抗结核化疗中影响血尿酸水平的主要药物及血尿酸水平的变化规律。方法选择已确诊的肺结核住院患者157例,均为肺结核病初治病人,无抗痨药治疗经历并且无痛风病史,检测所有接受系统化抗结核治疗的患者用药前、用药2,4,8,12,16周后的血尿酸水平。结果 157例肺结核病人在应用四联强化治疗期间,随着用药时间的延长,血尿酸水平不断升高。用药8周后,停用PZA,应用三联方案继续化疗,血尿酸水平从第9周开始逐渐下降至治疗前水平。结论抗结核药PZA可引起高尿酸血症(HUA)、关节肿痛,PZA所致HUA不一定导致继发性痛风的发生,停药后血尿酸水平很快回到正常水平,不影响化疗方案的实施。

Objective To analyze the changes of serumuric acid levels in 157 tuberculosis patients that were initial treatment before and after anti-tuberculosis chemotherapy and also after cessation of pyrazinamide. And to master the main drugs affecting the level of serum uric acid in anti-tuberculosis chemotherapy and the change rule of serum uric acid level. Methods A total of 157 confirmed TB inpatients,all of whom were first-time TB patients,had no history of anti-tuberculosis treatment and had no history of gout,were selected for all patients receiving systematic anti-tuberculosis treatment. In this study,all patients received systematic antituberculous therapy were tested for serumuric acid before medication and after medication in the second week,the fourth week,the eighth week,the twelfth week and in the sixteenth week. Results During the treatment with quadruple intensive therapy of 157 cases of tuberculosis patients,the level of serum uric acid increased with medication time prolonged. After 8 weeks of administration,pyrazinamide was stopped and chemotherapy continued with triple regimen. The level of uric acid decreased gradually from the 9 th week to the pre-treatment level. Conclusion Ntituberculosis drugs such as pyrazinamide can cause hyperuricemia,joint swelling and pain. Hyperuricemia caused by pyrazinamide dose not cause secondary gout necessarily. Uric acid levels quickly return to normal levels after the withdrawal of the drug. Therefore,hyperuricemia does not affect the completion of chemotherapy.