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目的:总结痛风临床病理特点。方法:回顾性分析1例痛风患者的生化机制、临床病理特征、刚果红染色、PAS染色特点、鉴别诊断要点,并复习相关文献。结果:患者主要临床表现为间断性多关节肿痛3年,加重伴发热3个月。体格检查发现患者有多发性皮下结节、多关节肿胀压痛。左腕、左肘皮下结节活检,经HE染色后光镜查见大量肉芽肿性病变,有的多核巨细胞内查见被吞噬的异物,有的病灶尚查见呈均质状物(尿酸盐结晶),其周围有较多异物巨细胞及纤维结缔组织包绕呈结节状,在结节的周边纤维血管周围可查见残留分化成熟的淋巴细胞及少数嗜酸性粒细胞。刚果红、PAS染色均为阴性。偏光显微镜下,刚果红未查见绿色强折光晶体,但见多量略呈淡黄色具有强折光性的晶体呈棒状或梭形。结论:痛风在刚果红染色偏光显微镜下观察呈淡黄色梭形或针状结晶,具有强折光性晶体,但这是否是痛风在刚果红染色的特征尚有待于进一步研究。
Objective: To summarize the clinicopathological features of gout. Methods: The biochemical mechanism, clinicopathological features, Congo red staining and PAS staining characteristics of 1 gout patients were retrospectively analyzed. The main points of differential diagnosis were reviewed. Relevant literatures were reviewed. Results: The main clinical manifestations of patients with intermittent polyarthritis pain for 3 years, increased with fever for 3 months. Physical examination found that patients have multiple subcutaneous nodules, multi-joint swelling tenderness. Left wrist, left elbow subcutaneous nodules biopsy, HE staining after light microscopy see a large number of granulomatous lesions, and some multinucleated giant cells found in the foreign body was phagocytosed, and some lesions were found to be homogeneous material (uric acid Salt crystals) around the more foreign body giant cells and fibrous connective tissue was nodular, peripheral fibrosis around the nodules can be found in the residual differentiation of mature lymphocytes and a small number of eosinophils. Congo red, PAS staining were negative. Under the polarizing microscope, Congo red did not detect the green strong refraction crystal, but see a little yellowish color with a strong refraction of the crystal was rod-shaped or fusiform. CONCLUSION: Gout is a light yellow fusiform or needle-like crystal observed under the Congo Red Staining Polarization Microscope with strong refraction crystals. However, whether Gout is characteristic of Congo red staining remains to be further studied.