高尿酸血症肾病42例临床分析.DOCVIP

临床医学论文-高尿酸血症肾病42例临床分析 【关键词】? 高尿酸 ??? 【摘要】 目的? 探讨高尿酸血症肾病的临床特征，提高对本病的认识。 方法? 对1995～2003年住院的42例原发性高尿酸血症肾病进行临床分析。 结果? 其占同期原发性痛风的75%，伴有关节损害者占81%。据BUN、Scr值，将患者分为非肾衰组与肾衰组。肾衰组合并高血压者显著高于非肾衰组;两组尿渗透压与血渗透压比值几乎均1.5;肾衰组血尿酸与血肌酐2.5的仅占50%，尿酸排泄量肾衰组较非肾衰组显著减少。 结论? 提示高尿酸血症性肾病多数伴有关节炎，肾小管功能损害出现在肾小球功能损害之前，肾衰时不能简单地根据血尿酸与血肌酐比值判断有无高尿酸血症肾病。 ??? 关键词? 高尿酸血症 肾损害 关节炎 ??? 【Abstract】 Objective To study the clinical characteristic of chronic uric acid nephropathy.Methods We investigated42cases of chronic uric acid nephropathy on patients hospitalized between1995and2003.Results It is about75%of the concurring gout，and81%of them were accompanied with arthritis.The patients were divided into renal failure group and non-renal failure group according to their blood uric nitrogen and serum creatinine parame-ters.While the both groups had similar uric osmotic pressure ratios（1.5），the renal failure group had a higher oc-currence of concurring hypertension.In the renal failure group，only50%had their blood uric acid/serum creatinine ratios greater than2.5，and the uric acid excretion was lower than that of the non-renal failure group.Conclusion This indicates that most of chronic uric acid nephropathy is accompanied with arthritis.The progress of renal failure is slow and predominated by tubular impairment at the early stage.Furthermore，uric acid nephropathy can not be diag- nosed simply with the ratio of blood uric acid/serum creatinine when renal failure encountered. ??? Key words hyperuricemia renal damage arthritis ??? 尿酸是嘌呤代谢的终末产物，嘌呤代谢紊乱或尿酸排泄减少可引起高尿酸血症。肾脏是尿酸的主要靶器官，也是影响其预后的重要因素。由于临床表现多样化，易误诊和漏诊。为提高对本病的认识，本文将我院1995～2003年收治的42例原发性高尿酸血症病例肾损害总结分析如下。 ??? 1 临床资料 ??? 1.1 一般资料 42例患者，占同期原发性痛风的75%，男36例（占86%），女6例。年龄41～82岁，平均61岁，50岁以上患者37例占88%。6例有家族史。 ??? 1.2 诊断标准 需同时具备以下两点，（1）原发性高尿酸血症:治疗前全部病例均有血尿酸高于正常，并能排除肾小球疾病、铅中毒、血液病、肿瘤放疗、化疗或长期应用利尿剂等继发性高尿酸血症。（2）尿异常:有不同程度蛋白尿或血尿。 ??? 1.3 临床表现 ??? 1.3.1 一般表现 42例高尿酸血症肾病患者，伴关节炎34例（81%），以第1跖趾关节痛为主者19例，占伴关节炎者56%，其次是指、踝、腕、膝关节，关节炎发作特点为突发夜间单关节疼痛，24h内可出现局部红肿热痛，活动受限，关节功能障碍伴随症状好转而消失;有痛风结节15例;X线检