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复发性痛风的预防：降尿酸盐药物治疗和痛风石的治疗

Author
Michael A Becker, MD
Section Editor
H Ralph Schumacher, MD
Deputy Editor
Paul L Romain, MD
Translators
刘蕊, 主治医师

引言

痛风是尿酸钠(monosodium urate, MSU)结晶沉积导致的疾病；当细胞外液未达到尿酸盐饱和[表现为高尿酸血症：血清尿酸盐水平>6.8mg/dL(405μmol/L)]并且没有尿酸盐结晶沉积和晶体沉积所致炎症反应时，患者不会发生痛风的症状和体征。此外，尚无证据表明，血清尿酸盐下降但水平仍高于尿酸盐溶解度限度会带来相当于达到尿酸盐亚饱和水平的临床益处。因此，痛风可被视为一种“阈值”疾病，预防痛风复发和逆转既往表现的长期治疗目标是使血清尿酸盐浓度降至亚饱和水平，并加以维持。

用于预防急性痛风复发以及尿酸盐结晶沉积所致关节及其他组织损伤的处理方法包括药物治疗、生活方式改变和其他降低风险的策略。长期成功维持亚饱和尿酸盐水平的临床益处包括：急性痛风发作停止、痛风石溶解以及患者身体机能和健康相关生活质量改善。但即使是通过改变生活方式(降低风险)和/或口服降尿酸药物使尿酸盐达到亚饱和水平后，患者仍可能需要数月至数年时间才能消除尿酸盐晶体负荷。在晶体溶解期间，急性痛风发作的风险仍然存在，这是使用抗炎药物预防痛风发作的主要原因。

本文将总结利用降尿酸盐药物和痛风石治疗来预防复发性痛风和疾病进展的问题，以及在抗高尿酸血症治疗初期针对急性痛风性关节炎使用抗炎预防的问题。复发性痛风和疾病进展的预防(利用非药物性生活方式改变来降低尿酸盐，以及降低风险措施，包括治疗高血压等共存疾病时的药物选择)，痛风的临床表现和诊断，急性痛风性关节炎发作的治疗，以及无症状高尿酸血症的相关问题，均将单独讨论。 (参见“复发性痛风的预防：生活方式改变和降低风险的其他策略”和“痛风的临床表现和诊断”和“急性痛风的治疗”和“无症状性高尿酸血症”)

处理原则

在大多数痛风性关节炎患者中，使血清尿酸盐达到亚饱和水平并加以维持即可成功控制疾病，相关措施包括改变生活方式/降低风险策略，通常也需要联合药物治疗。痛风石性痛风患者常需要降尿酸盐药物治疗，但在一些由痛风石性疾病导致并发症的患者中，内科治疗可辅以外科干预。对于有大型痛风石沉积的肾功能受损患者，治疗可能更加困难。

在急性痛风发作消退后，患者就进入了发作间期(两次发作之间)(参见“痛风的临床表现和诊断”，关于‘间歇期痛风和复发性痛风性关节炎’一节)；在此期间应落实下列预防措施：

                                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-18.
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