不同剂量泮托拉唑诱发稳定期痛风性关节炎再发作的临床观察

Clinical observation of different doses of pantoprazole inducing recurrent gouty arthritis in stable stage

目的 分析不同剂量泮托拉唑对急性上消化道出血合并稳定期痛风性关节炎患者痛风再发作的影响。方法 回顾性分析2018年1月至2020年6月厦门大学附属东南医院收治72例急性上消化道出血患者的临床资料,其中合并痛风性关节炎患者27例、未合并者45例。Blatchfbrd评分≥6分或内镜止血效果不佳/止血困难的患者采用高剂量泮托拉唑治疗(80 mg 0.5 h静脉滴注后,予8 mg/h静脉泵注72 h),其余患者予低剂量泮托拉唑治疗(40 mg/次、2次/d静脉滴注,连续治疗3 d)。治疗3 d后,所有患者续予泮托拉唑40 mg, 1次/d静脉滴注,持续3 d。记录患者治疗前及治疗3、6 d血尿素氮、血肌酐、血尿酸水平,统计治疗后痛风发作持续时间、关节肿痛、发热情况。结果 45例未合并痛风性关节炎患者中,接受低剂量泮托拉唑治疗20例(A组)、高剂量泮托拉唑治疗25例(B组);27例合并痛风性关节炎患者中,接受低剂量泮托拉唑治疗11例(C组)、高剂量泮托拉唑治疗16例(D组)。治疗前后,各组患者血尿素氮、血肌酐水平比较,差异均无统计学意义(均P>0.05)。治疗前,各组患者血尿酸水平比较,差异无统计学意义(P>0.05);治疗3、6 d, B组患者血尿酸水平均高于A组[(481±104)μmol/L比(473±90)μmol/L、(492±99)μmol/L比(484±73)μmol/L],D组均高于C组[(546±98)μmol/L比(510±90)μmol/L、(566±90)μmol/L比(522±85)μmol/L],差异均有统计学意义(均P<0.05)。C组与D组痛风发作持续时间、单关节痛比例、多关节痛比例、发热比例比较,差异均无统计学意义(均P>0.05)。A、B组均未出现关节肿痛。结论 使用大剂量泮托拉唑可促使上消化道出血患者血尿酸水平明显升高,但是否引起稳定期痛风性关节炎患者痛风再发作,仍需进一步研究。

Objective To analyze the impact of different doses of pantoprazole on recurrence of gout in patients with acute upper gastrointestinal bleeding complicated with stable gouty arthritis. Methods From January 2018 to June 2020, clinical data of 72 patients with acute upper gastrointestinal bleeding admitted to the Affiliated Dongnan Hosptial of Xiamen University were retrospectively analyzed. Of which 27 cases were complicated with gouty arthritis and 45 cases were not. Patients with Blatchfbrd score ≥6 or with poor hemostatic effect of endoscopy/difficulty in hemostasis were treated with high-dose of pantoprazole(80 mg 0.5 h intravenous drip and then 8 mg/h intravenous pumping for 72 h), and others were treated with low-dose of pantoprazole(40 mg/time, 2 times/d intravenous drip for 3 d). After above treatment, all patients were treated with pantoprazole 40 mg/time, 1 time/d intravenous drip for 3 d. The levels of blood urea nitrogen, serum creatinine and serum uric acid before treatment, 3 and 6 d after treatment, as well as joint pain and fewer in patients were recorded. Results Among 45 cases without gouty arthritis, there were 20 cases treated with low-dose of pantoprazole(group A) and 25 cases treated with high-dose of pantoprazole(group B);among 27 cases with gouty arthritis, there were 11 cases treated with low-dose of pantoprazole(group C) and 16 cases treated with high-dose of pantoprazole(group D). There were no significant differences in levels of blood urea nitrogen and serum creatinine among the groups before and after treatment(all P>0.05). There was no significant difference in the level of serum uric acid among the groups before treatment(P>0.05);3 and 6 d after treatment, the level of serum uric acid in group B was higher than that in group A [(481±104)μmol/L vs(473±90)μmol/L,(492±99)μmol/L vs(484±73)μmol/L], and that in group D was higher than that in group C [(546±98)μmol/L vs(510±90)μmol/L,(566±90)μmol/L vs(522±85)μmol/L](all P<0.05). There were no significant differences in duration of gout onset, single joint pain rate, multiple joints pain rate and fever rate(all P>0.05). Joint swelling and pain was not found in group A and group B. Conclusion High-dose of pantoprazole can significantly increase the level of serum uric acid. However, whether it causes recurrent gout in patients with stable gouty arthritis needs further research.