摘要:
目的:探讨维生素C对痛风性关节炎首次发作后预防再发的疗效.方法:将2017年1-9月来本院就诊的40例痛风性关节炎首次发作患者, 按照随机数字表法将患者分为对照组和观察组, 每组20例.观察组口服维生素C (500 mg/d), 对照组不予任何药物干预, 随诊1年.在治疗前及治疗后第3、6、9、12个月检查血尿酸 (blood uric acid, BUA) 、甘油三酯 (triglyceride, TG) 、总胆固醇 (total cholesterol, TC) 、血清肌酐 (Scr) 及尿尿酸 (urine uric acid, UUA) 、尿p H值, 记录两组患者痛风性关节炎再次复发状况.比较两组数据, 分析维生素C对痛风性关节炎患者血尿酸及尿尿酸水平的影响.结果:两组患者不同时间点血清BUA、TG、Scr含量比较, 差异均有统计学意义 (P<0.05), 与治疗前比较, 对照组治疗后第6、9、12个月时血清BUA、TG、Scr含量均降低, 观察组治疗后第3、6、9、12个月时血清BUA、TG、Scr含量均降低;观察组治疗后第6、9、12个月时血清BUA、TG、Scr含量均低于同时期的对照组, 差异均有统计学意义 (P<0.05) .两组不同时间点TC比较, 差异均无统计学意义 (P>0.05) .两组患者不同时间点24 h尿尿酸、尿pH值比较, 差异均有统计学意义 (P<0.05), 与治疗前比较, 对照组治疗后第6、9、12个月24 h尿尿酸、尿pH值均升高, 观察组治疗后第3、6、9、12个月24 h尿尿酸、尿pH值均升高;观察组治疗后第6、9、12个月24 h尿尿酸、尿pH值均高于同时期的对照组, 差异均有统计学意义 (P<0.05) .观察患者未出现中断治疗、死亡及失随病例, 未出现不良反应.对照组复发率为35.00%, 高于观察组的5.00%, 差异有统计学意义 (P<0.05) .对照组复发患者VAS评分为 (4.15±0.77) 分, 高于观察组复发患者的 (2.89±0.31) 分, 差异有统计学意义 (P<0.05) .结论:维生素C对痛风性关节炎首次发作后再发有显著的预防作用, 能降低血清尿酸含量, 增加尿酸排泄, 缓解疼痛程度, 且安全性高, 值得临床推广.%Objective:To investigate the effect of Vitamin C on preventing recurrence of gouty arthritis after the first attack.Method:40 gouty arthritis patients who came to our hospital from January 2017 to September 2017 were selected, patients were divided into control group and observation group according to the random number table method, 20 cases in each group.The observation group was given Vitamin C (500 mg/d) orally, and the control group was not given any drug intervention, follow up for 1 year.Blood uric acid (BUA), triglyceride (TG), total cholesterol (TC), creatinine (Scr) and 24-hour urine uric acid (UUA), uric acid concentration and urine pH value were examined before the treatmentat and 3, 6, 9, 12 months after treatment, the recurrence of gouty arthritis in two groups were recorded.The effects of Vitamin C on serum uric acid and 24-hour uric acid levels in patients with gouty arthritis were analyzed.Result:Comparison of serum BUA, TG, Scr content between the two groups at different time points showed statistically significant differences (P<0.05) ;compared with before treatment, the serum BUA, TG, Scr content in the control group decreased at 6, 9 and 12 months after treatment, while those in the observation group decreased at 3, 6, 9 and 12 months after treatment;at the 6, 9 and 12 months after treatment, the serum BUA, TG, Scr content of the observation group were lower than those of the control group at the same period, the differences were statistically significant (P<0.05).There were no statistically significant differences in TC between the two groups at different time points (P>0.05).The pH value of urine urinuria 24 h at different time points in the two groups were compared, the differences were statistically significant (P<0.05).Compared with before treatment, the urine pH and 24 h urine uric acid in the control group increased after treatment 6, 9 and 12 months, while those in the observation group increased after treatment 3, 6, 9 and 12 months;the urine pH value and 24 h uric acid urine in the observation group after treatment 6, 9 and 12 months were higher than those in the control group at the same period, the differences were statistically significant (P<0.05).The patients were observed to have no death or loss of follow-up after treatment, and no adverse reactions were observed.The recurrence rate of the control group was 35.00%, higher than 5.00% of the observation group, the difference was statistically significant (P<0.05).The VAS score of the relapse patients in the control group was (4.15±0.77), higher than (2.89±0.31) of the relapse patients in the observation group, the difference was statistically significant (P<0.05).Conclusion:Vitamin C has a significant preventive effect on the recurrence of gout arthritis after the first attack, it can reduce the content of serum uric acid, increase the excretion of uric acid, relieve the degree of pain, and has high safety, which is worthy of clinical promotion.