替格瑞洛诱发痛风性关节炎

Gouty arthritis induced by ticagrelor

1例56岁男性患者因急性ST段抬高型心肌梗死行经皮冠状动脉介入治疗,术后联合使用阿司匹林肠溶片100 mg口服、1次/d和替格瑞洛90 mg口服、2次/d抗血小板聚集。患者有痛风病史20余年。用药第24天,患者出现发热及多个关节红、肿、热、痛症状。实验室检查示白细胞计数9.8×10^(9)/L,中性粒细胞0.83,血尿酸538μmol/L;关节超声检查示部分关节囊肿胀增厚、软组织局限性增厚、关节软骨处散在结晶沉积。诊断:痛风性关节炎。考虑痛风性关节炎可能与替格瑞洛有关。停用该药,应用原剂量阿司匹林+氯吡格雷(75 mg口服、1次/d)双联抗血小板治疗,同时予饮食控制、加强运动、降尿酸等治疗。10 d后复查,血尿酸为287μmol/L。故恢复阿司匹林+替格瑞洛双联抗血小板治疗,此后未再出现痛风性关节炎发作。

A 56-year-old male patient underwent percutaneous coronary intervention(PCI)due to acute ST elevation myocardial infarction.He received a combination therapy with aspirin enteric coated tablets 100 mg orally once daily and ticagrelor 90 mg orally twice daily for antiplatelet aggregation after the PCI.The patient had a history of gout for more than 20 years.On the 24th day of medication,the patient developed fever and the symptoms of redness,swelling,heat,and pain in multiple joints.Laboratory tests showed white blood cell count 9.8×10^(9)/L,neutrophils 0.83,and blood uric acid 538μmol/L.Ultrasonography of the joints showed swelling and thickening of some joint cysts,limited thickening of soft tissue,and scattered crystalline deposits on the articular cartilage.He was diagnosed as having gouty arthritis,which might be associated with ticagrelor.Ticagrelor was stopped.The patients were treated with dual antiplatelet therapy consisting of aspirin 100 mg orally once daily and clopidogrel 75 mg orally once daily.At the same time,the treatments of diet control,strengthening exercise,and urate lowering drugs were given.Ten days later,the result of reexamination showed that serum uric acid was 287μmol/L.Therefore,dual antiplatelet therapy with aspirin and ticagrelor was resumed,and no further gouty arthritis attacks occurred.