【晨读】痛风的最新指南（二）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Drug and Therapeutics Bulletin. Latest guidance on the management of gout. BMJ. 2018 Jul 18;362:k2893. 本次学习由阎芳副研究员主讲。

Is gout associated with particularcomorbidities or lifestyles?

There is no consistent evidence that an elevated serum uric acidlevel results in coronary heart disease, reduced renal function,hypertension, or type 2 diabetes. There is some evidence thata raised serum uric acid level might be associated with worseoutcomes in people with cardiovascular and renal disease. Sothe British Society of Rheumatology recommends that peoplepresenting with gout are assessed for cardiovascular risk factors,including cigarette smoking, hypertension, diabetes,dyslipidaemia, obesity, and renal disease.

痛风是否与特定的合并症或生活方式有关？

没有一致的证据表明血清尿酸水平升高会导致冠心病、肾功能下降、高血压病或2型糖尿病。有证据表明，血清尿酸水平升高可能与心血管和肾脏疾病患者的不良预后有关。因此，英国风湿病学会建议对痛风患者进行心血管危险因素评估，包括吸烟、高血压、糖尿病、血脂异常、肥胖和肾病。

Although observational studies suggest an association betweendietary factors and gout development, there is no high qualityevidence from randomised controlled trials. There is limitedevidence that weight loss is associated with a small reductionin serum uric acid levels. Guidelines recommend that patientsare provided with appropriate lifestyle advice on exercise,weight management, and healthy eating aimed at reducingcardiovascular risk and other related comorbidities.

虽然观察性研究表明饮食因素与痛风的发生有关联，但是没有高质量的随机对照试验证据。有限的证据表明，体重减轻可带来血清尿酸水平的轻度降低。指南建议应向患者提供适当的生活方式的相关建议，包括运动、体重控制和健康饮食方面的建议，以降低心血管风险和其他相关的并发症的发生。

Treatment of acute gout

Treatment for an acute attack should be started as soon aspossible.2 10 11 Non-steroidal anti-inflammatory drugs (NSAIDs)and colchicine are recommended as first line treatment optionsfor an acute attack, with systemic corticosteroids generally restricted to those people who don’t respond to, or cannottolerate, NSAIDs or colchicine.

急性痛风的治疗

痛风急性发作时，应尽快采取相关治疗。非甾体抗炎药（NSAIDs）和秋水仙碱被推荐为痛风急性发作的一线治疗方案，全身应用皮质类固醇一般仅限于对NSAIDs或秋水仙碱无反应或不能耐受的人群。

NSAIDs

Although guidelines recommend using an NSAID for acutegout flares, the authors of a Cochrane review (23 trials, 2200participants) found limited evidence supporting the use ofNSAIDs in the treatment of acute gout. However, theynoted that the data did not conflict with clinical guidelinerecommendations that were largely based on observational data,expert opinion, and use in other inflammatory conditions. Interms of pain relief, there was some evidence that systemicglucocorticoids and NSAIDs were equally beneficial.

非甾体抗炎药

尽管指南建议使用非甾体抗炎药治疗急性痛风发作，但一项系统性综述（23项试验，2200名参与者）的作者发现，支持使用非甾体抗炎药治疗急性痛风发作的证据有限。不过, 作者指出，这些数据与临床指南的建议并不冲突，因为指南的建议主要基于观察数据、专家意见和在其他炎症条件下的应用情况提出的。在减轻疼痛方面，有一些证据表明全身糖皮质激素和非甾体抗炎药同样有益。

There are no clinically important differences between NSAIDsin patients with gout. NSAIDs may not be suitable for patientswith comorbidities (such as reduced renal function, heart failure,cardiovascular disease, and current or previous gastrointestinalperforation, ulcer, or bleeding). A proton pump inhibitor shouldbe offered to people at high risk of NSAID-relatedgastrointestinal complications。

在对痛风的治疗中，不同的非甾体抗炎药的效果没有显著的临床差异。非甾体抗炎药可能不适用于一些合并症（如肾功能减退、心力衰竭、心血管疾病、目前或既往胃肠道穿孔、溃疡或出血）的患者。针对可能发生非甾体抗炎药相关胃肠道并发症的高危人群，应预防性使用质子泵抑制剂。