血浆免疫吸附治疗难治性急性痛风性关节炎临床研究

Clinical study of plasma adsorption in treatment of refractory acute gouty arthritis

目的:探讨血浆免疫吸附(PA)治疗急性痛风性关节炎(AGA)的疗效及安全性。方法:选择6例经3次HA280树脂血液灌流器治疗的AGA患者与同期住院的10例应用常规治疗方案的AGA患者进行临床数据对比分析。结果:两组患者一般情况比较(性别、年龄、病程、治疗前血沉、肝肾功能、血糖、疼痛评分、血尿酸值等)差异无统计学意义,免疫吸附AGA患者关节红肿热痛症状明显缓解,血沉、C反应蛋白等炎症指标均明显下降,提示PA能够通过清除AGA患者机体相关炎症因子,快速有效地控制AGA患者全身炎症反应。与常规治疗方案组相比,PA治疗组患者治疗过程中糖皮质激素、秋水仙碱及非甾体抗炎药等药物的使用总剂量减少,肝肾功能无明显变化,血糖水平更加稳定,表明PA治疗具有良好的安全性。治疗半年内PA治疗组患者的复发率更低,再发疼痛程度更轻、累及关节数量更少,提示免疫吸附治疗相较于常规药物治疗对AGA的长期控制更为有效。结论:PA可作为一种新型手段应用于难以耐受常规治疗药物及常规治疗效果不佳的难治性急性痛风性关节炎的临床治疗。

Objective:To explore the efficacy and safety of plasma immunoadsorption(PA)in treatment of acute gouty arthri-tis(AGA).Methods:Clinical data were compared and analyzed between 6 AGA patients treated with HA280 resin hemoperfusion device three times and 10 AGA patients hospitalized in the same period who received conventional treatment.Results:There was no statistically significant difference in general situation between two groups of patients(gender,age,course of disease,pre treatment erythrocyte sedimentation rate,liver and kidney function,blood glucose,pain score,blood uric acid value,etc.).Symptoms of joint redness,swelling,and pain in immune adsorption AGA patients were significantly alleviated,and inflammatory indicators such as erythrocyte sedimentation rate and C-reactive protein were significantly reduced,which suggests that PA can quickly and effectively control the systemic inflammatory response of AGA patients by clearing relevant inflammatory factors in their bodies.Compared with conventional treatment group,PA treatment group showed a decrease in the total dose of glucocorticoids,colchicine,and non-steroidal antiinflammatory drugs used during treatment process,with no significant changes in liver and kidney function,and more stable blood sugar levels,which indicating that PA treatment has good safety.Within six months of treatment,patients in PA treatment group had lower recurrence rate,less recurrent pain,and fewer joint involvement,which indicating that immunosorbent therapy is more effective in long-term control of AGA compared to conventional drug therapy.Conclusion:PA can be used as a new method for clinical treat-ment of refractory acute gouty arthritis that is difficult to tolerate conventional treatment drugs and has poor efficacy in conventional treatment.