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目的探讨老年原发性慢性痛风关节炎3种不同的治疗方法的疗效、安全性和复发的相关因素。方法将2004-03~2005-04湖州市第三人民医院的87例老年原发性慢性痛风关节炎患者随机分为3组:A组31例采用一般治疗,B组32例在一般治疗的基础上加用羟氯喹维持治疗,C组24例在一般治疗基础上加用秋水仙碱维持治疗;观察期12个月。结果A、B、C3组病人治疗前后比较,痛风急性发作次数及血尿酸浓度明显下降(P<0·05)。B组、C组与A组比较,急性痛风关节炎发作次数更少(P<0·05)。入组前相关危险因素调查,不规范饮食控制、不规范使用激素、降尿酸药物、利尿药物、阿司匹林是老年慢性痛风关节炎急性复发的主要诱因,且多数为医源性。因药物相关的不良事件而终止观察,3组分别为A组4例(12·9%),B组3例(9·4%),C组11例(45·8%)。C组高于A、B组(P<0·05)。结论小剂量秋水仙碱、羟氯喹可减少老年慢性痛风关节炎的急性发作次数及降低血尿酸浓度;羟氯喹作为预防性治疗其耐受性和安全性可能更好;老年痛风关节炎患者须规范使用降尿酸药物,慎用利尿剂、阿司匹林。
Objective To investigate the efficacy, safety and relapse factors of three different therapies for senile primary chronic gouty arthritis. Methods A total of 87 elderly patients with primary chronic gouty arthritis who were admitted to the Third People’s Hospital of Huzhou City from March 2004 to April 2005 were randomly divided into three groups: 31 cases in group A received general treatment, and 32 cases in group B were the basis of general treatment On the addition of hydroxychloroquine maintenance treatment, C group 24 cases based on the general treatment with colchicine maintenance treatment; observation period of 12 months. Results Before and after treatment, the number of acute attacks and serum uric acid in group A, B and C3 were significantly decreased (P <0.05). In group B, group C had fewer episodes of acute gouty arthritis compared with group A (P <0.05). Investigation of relevant risk factors before entering the group, non-standard diet control, irregular use of hormones, uric acid lowering drugs, diuretic drugs and aspirin are the main causes of acute relapse of elderly patients with chronic gouty arthritis, and most of them are iatrogenic. Four patients (12.9%) in group A, 3 patients (9.4%) in group B, and 11 patients (45.8%) in group C were discontinued because of drug-related adverse events. C group was higher than A, B group (P <0.05). Conclusions Small doses of colchicine and hydroxychloroquine can reduce the number of acute episodes of chronic gouty arthritis and lower serum uric acid concentrations in elderly patients. Hydroxychloroquine may be better tolerated and safe as a prophylactic treatment. Elderly patients with gouty arthritis should be standardized Use uric acid drugs, used with caution diuretics, aspirin.