原发性骨髓纤维化引起的继发性痛风1例  

A case of gout secondary to primary myelofibrosis

作　　者：季兰岚[1] 郝燕捷[1] 张卓莉[1] JI Lan-lan;HAO Yan-jie;ZHANG Zhuo-li(Department of Rheumatology and Immunology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院风湿免疫科,北京100034

出　　处：《北京大学学报（医学版）》2018年第6期1117-1119,共3页Journal of Peking University:Health Sciences

摘　　要：1病例资料患者男性,52岁,主因"间断多关节肿痛2年余"入院。患者2年前无诱因出现双足背肿痛,疼痛程度剧烈,局部发热红肿,外院诊断为"痛风",应用激素治疗有效。此后患者间断发作上述症状,约2～3 d疼痛最高,1周左右缓解,与饮食、天气等无明显相关。1年前发作关节逐渐累及双侧肘关节、腕关节、掌指关节(metacarpal phalangeal,MCP)及近端指间关节(proximal interphalangeal,PIP),双侧交替发作，并出现手背、掌指关节处皮下结节，伴晨僵20min，伴双腕、双肘关节活动受限。A 52-year-old man was referred to our department with a 2-year history of polyarthritis. He was diagnosed as gout due to acute arthritis of bilateral feet dorsum 2 years ago,but he didn＇t receive any standard treatment. 1 year ago,there were more and more joints evolved during the gout attack,and many subcutaneous nodules occurred. When he presented to our clinic 1 month ago,the urate acid level was as high as 715 μmol/L. Moreover,we could find bone erosion in the X rays of his hand and foot,as well as synovitis,double contour sign and tophus on the ultrasound examination. The diagnosis of gout was clearly and definitely. However,he had leukocytosis and thrombocytosis for 4 years in the past history,and the urate acid level was only 400 μmol/L at that time. He also had well-controlled hypertension. The family history was unremarkable. Furthermore,we found megalosplenia on his physical examination. The bone marrow examination showed myelofibrosis and JAK2 V617 F gene was positive. He was diagnosed as primary myelofibrosis and treated with interferon-α,together with urate acid-lowing therapy（ febuxostat 60 mg once daily）. Following-up for 1 year,the dosage of febuxostat decreased to 40 mg once daily,and the patient didn＇t have gout attack again,some of the tophus diminished,and the urate acid level ranged from400 to 500 μmol/L. Gout is a common disease in clinical practice,usually combined with metabolic syndrome,chronic renal failure and specific drugs using（ diuretic and calcineurin inhibitors）. However,it is relatively rare to see gout associated with myeloproliferative diseases,including polycythemia vera,primary thrombocythemia,primary myelofibrosis and chronic myelocytic leukemia. In these diseases,the turnover of nucleic acids is greatly augmented,and an excess of purine metabolites,including uric acid,is released. In the natural course of gout,the appearance of tophus from the first onset of arthritis usually takes several years. This patient only had one traditional risk factor,but his urat

关 键 词：继发性痛风 痛风石 原发性骨髓纤维化 骨髓增殖性疾病 

分 类 号：R593[医药卫生—内科学]