版acr痛风管理指南宋立军 技术方案.pptxVIP

2012版ACR痛风管理指南山东大学齐鲁医院风湿科宋立军Gout has been called “king of diseases” 病中之王 “disease of kings” 王者之病Today, the term gout is used to represent a heterogeneous group of diseases found exclusively in humans that include the following characteristics:1.?? Elevated serum urate concentration (hyperuricemia)高尿酸血症Hyperuricemia is defined as a serum urate level greater than 6.8 mg/dL?2. Recurrent attacks of acute arthritis in which monosodium urate monohydrate crystals are demonstrable in synovial fluid leukocytes 急性痛风性关节炎反复发作3.? Aggregates of sodium urate monohydrate crystals (tophi) deposited chiefly in and around joints, which sometimes lead to deformity and crippling尿酸盐单水晶体在关节及其周围的聚集（痛风石）4.? Renal disease involving glomerular, tubular, and interstitial tissues and blood vessels 肾脏病变5. Uric acid nephrolithiasis 尿酸结石Acute attacks rarely affect the shoulders, hips, spine, sacroiliac joints, sternoclavicular joints, acromioclavicular joints, or temporomandibular joints.Urate deposition and subsequent gout appear to have a predilection for previously damaged joints, such as in Heberdens nodes of older women.The course of untreated acute gout is highly variable. Mild attacks may subside in several hours or persist for only a day or two and never reach the intensity described for the classic attack. Severe attacks may last days to weeks.痛风管理的基础性建议痛风患者应该学习合理的饮食习惯和生活习惯需要避免引起继发性高尿酸血症的因素除非必须，否则避免使用引起尿酸增高的药物需要评估痛风的严重程度（是否有痛风石，痛风的发作次数等等）痛风的非药物治疗指南首先强调了患者宣教的重要性，单纯饮食及生活方式干预可在一定程度上起到降尿酸和（或）预防急性痛风关节炎发作的作用。饮食控制① 限制短时间内大量摄入富含嘌呤的食物，限制富含嘌呤的肉类、海鲜及果糖饮料的摄入，推荐低脂或脱脂乳制品和蔬菜；② 减少酒精摄入（特别是啤酒、白酒和烈酒），避免酗酒，疾病活动的患者须戒酒，尤其是药物无法有效控制病情进展及慢性痛风性关节炎患者。研究人员将食物建议分为三类：避免食用、限制食用和鼓励食用。客观的说，这些建议都是来自某些孤立的临床研究，而不是大规模多中心临床研究或meta分析。关于某些食物（樱桃、坚果和豆类）的建议研究人员也有分歧。避免食用：富含高嘌呤的动物内脏、果糖含量高的甜食饮料和汽水。痛风发作期间避免饮酒，非发作期间也需严格限酒。限制食用：牛肉、羊肉、猪肉、嘌呤含量高的海鲜（沙丁鱼和贝壳类）、自然很甜的果汁、食盐和酒（尤其是啤酒）。鼓励食用：低脂乳制品和蔬菜。急性痛风性关节炎发作的基本治疗原则急性痛风性关节炎发作必须采取药物治疗，且最好在发病之初的24小时内开始。如果在ULT过程中出现急性痛风性关节炎发作，不须暂停降尿酸药物。要让患者知道诱发痛风性关节炎急性发作的原因，一旦发作，患者应知晓基本处理原则；要让患者认识到痛风是体内尿酸过度积累所致，只有进行有