质子泵抑制剂对痛风性关节炎急性发作的影响  

Effect of proton pump inhibitors on acute gouty arthritis attacks in patients with a history of gout

作　　者：滕秋娴 何玉玲[2] TENG Qiuxian;HE Yuling(Department of Endocrinology and Metabolism,Guangxi Zhuang Autonomous Regional Corps Hospital,Chinese People’s Armed Police Forces,Nanning 530003,Guangxi,China;Department of Geriatric Endocrinology and Metabolism,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China)

机构地区：[1]中国人民武装警察部队广西壮族自治区总队医院内分泌代谢病科,广西南宁530003 [2]广西医科大学第一附属医院老年内分泌代谢病科,广西南宁530021

出　　处：《右江民族医学院学报》2024年第3期347-350,370,共5页Journal of Youjiang Medical University for Nationalities

摘　　要：目的探讨既往有痛风病史患者禁食条件下使用质子泵抑制剂(proton pump inhibitors,PPIs)对痛风性关节炎急性发作的影响。方法选取广西医科大学第一附属医院2015年1月至2020年9月既往确诊痛风且在禁食期间使用PPIs治疗的43例住院患者为研究组,同期既往确诊痛风且在禁食期间未使用PPIs治疗的43例住院患者为对照组,对两组相关指标进行统计学分析。结果研究组痛风发作率明显比对照组痛风发作率高;痛风急性发作患者研究组与对照组比较血尿酸、血肌酐升高,HCO_(3)^(-)下降(P<0.05);PPI治疗组患者使用PPIs治疗前后生化指标,血尿酸值、血肌酐值均较用药前升高(P<0.05),而血清HCO^(3)^(-)、血K^(+)、血Na^(+)、血Cl^(-)均较用药前下降(P<0.05)。结论既往有痛风病史患者禁食条件下使用PPIs可能诱发痛风急性发作,推测PPIs在特定条件下诱发痛风急性发作可能与抑制肾小管中H^(+)-K^(+)-ATP酶的活性,影响肾小管酸碱平衡导致尿酸排泄障碍引起尿酸增高有关。Objective To investigate the effect of proton pump inhibitors(PPIs)on acute gouty arthritis attacks in patients with a previous history of gout under fasting conditions.Methods From January 2015 to September 2020,at the First Affiliated Hospital of Guangxi Medical University,43 patients with a confirmed diagnosis of gout who received PPIs treatment during fasting periods were enrolled in the study group,while another 43 patients with a confirmed diagnosis of gout who did not receive PPIs treatment during fasting periods were included in the control group.Statistical analysis was then performed on relevant indicators between the two groups.Results The incidence of acute gouty arthritis attacks in the study group was significantly higher than in the control group.Compared with the control group,patients in the acute gouty arthritis attack group had increased serum uric acid and serum creatinine levels,along with decreased HCO^(3)^(-)levels(P<0.05).In the PPIs treatment group,biochemical indices after PPIs treatment showed higher serum uric acid and serum creatinine levels(P<0.05),while serum HCO_(3)^(-),blood K^(+),blood Na^(+)and blood Cl^(-)levels were lower than before treatment(P<0.05).Conclusion The use of PPIs under fasting conditions in patients with a previous history of gout may trigger acute gouty arthritis attacks.It is speculated that PPIs,under certain conditions may induce acute gouty arthritis attacks by inhibiting the activity of H^(+)-K^(+)-ATPase in the renal tubules,impacting the acid-base balance in the renal tubules,and leading to impaired uric acid excretion and subsequent hyperuricemia.

关 键 词：质子泵抑制剂 痛风 急性发作 H^(+)-K^(+)-ATP酶 

分 类 号：R589.7[医药卫生—内分泌]