难治性痛风1例的文献复习

Literature review of a case of refractory gout

2020年1月8日重庆市中医院收治1例33岁男性诊断为难治性痛风,并发症较多。予以小剂量激素和非甾体类抗炎药口服、局部关节腔灌注治疗及重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(益赛普)皮下注射后效果不佳,改为大剂量激素静脉滴注治疗病情缓解。5 d后患者再发高热,无关节肿痛,发现患者肛周脓肿,予局部穿刺抽脓和抗生素静滴抗感染治疗,患者住院19 d症状缓解出院。对该病例进行总结分析,提示难治性痛风的治疗时当一线药物常规剂量无效时,可尝试大剂量治疗,同时管理并发症亦尤为重要。

On January 8,2020,a 33-year-old man was admitted to Chongqing Traditional Chinese Medicine Hospital and was diagnosed as refractory gout with many complications.He was given oral administration of low-dose hormone and non-steroidal anti-inflammatory drugs,local joint cavity perfusion therapy and subcutaneous injection of recombinant human tumor necrosis factor receptor typeⅡ-antibody fusion protein(Yisaipu).He had little effect and changed to high-dose hormones intravenous drip treatment.His condition has been relieved.Five days later,the patient recurred high fever without joint swelling and pain.The patient was found to have a perianal abscess.He was treated with local puncture and pus and intravenous antibiotics for anti-infection treatment.The patient was discharged from the hospital after 19 days.A summary analysis of this case suggested that in the treatment of refractory gout,when the conventional dose of first-line drugs was ineffective,high-dose treatment could be tried,and management of complications was also particularly important.