193例痛风患者的临床症状分析

发布时间：2018-06-24 20:40

本文选题：痛风 + 临床症状　；参考：《河南中医学院》2015年硕士论文

【摘要】：痛风是由于嘌呤代谢紊乱及/或尿酸排泄减少所引起的一种代谢性疾病,尿酸盐结晶沉积是诱发痛风性关节炎发作的病理基础,大多数痛风患者临床表现为痛风性关节炎的反复发作,且多骤然发作并伴剧烈疼痛,极为影响人们的生活。随着社会经济的飞速发展,人民生活水平的提高,饮食结构的变化,目前国内外研究均表明其发病率呈逐年升高并年轻化的趋势,且好发于中年男性及绝经后女性。因痛风所致一系列并发症也将随之增多,因此对痛风的早期诊断及治疗可有效提高痛风患者的生活质量,尽可能的降低痛风所带来的危害。近年来对尿酸盐结晶的检查,国内外采用先进的双源CT痛风识别技术开展临床研究与分析,并用于痛风的鉴别诊断,但国内外的研讨多围绕急性痛风性关节炎发作期进行,对痛风患者临床症状多样性的资料尚少。本研究通过临床观察,痛风患者临床症状表现为关节疼痛、关节肿胀、活动受限、关节压痛、肢体麻木、肢体发凉、肢体困沉、畏寒怕冷、关节潮红/发热、指端苍白等,可见痛风的临床表现不单单是传统意识上的单个或多个关节剧烈的红肿热痛,其临床表现具有多样性、复杂性。目的:采用先进的双源CT痛风识别技术,对193例痛风患者手足部位尿酸盐结晶沉积进行观察分析,了解其主要临床表现,记录其症状积分,并对其尿酸盐结晶进行影像学分级,观察临床症状与尿酸盐结晶沉积的关联性;探讨痛风患者临床症状与血尿酸之间的关系;观察手指特异性变化,并将其量化,观察临床症状积分与其之间的关联性。方法:选取符合诊断标准的痛风病人193例,男111例(58%),女82例(42%),所有病人均来自于2013年4月至2014年8月周围血管科门诊病人。签署知情同意书,详细记录患者姓名、性别、年龄、临床症状、手指特异性变化等,并行双源CT尿酸盐结晶成像及血尿酸值检查,观察、记录尿酸盐结晶沉积部位、数量,并将临床症状、手指特异性变化进行量化,整理所得数据并对其作统计学处理。结果:1.193例痛风患者中均发现尿酸盐结晶沉积,共统计双手足尿酸盐结晶沉积部位240个。痛风患者临床表现以关节疼痛最多,其次为关节肿胀、活动受限、关节压痛、肢体麻木、肢体发凉等。2.根据血尿酸分组,两组间血尿酸值经t检验,t=-16.201,P=0.000,P0.05,组间血尿酸差异有统计学意义;两组间临床症状积分经t检验,t=-0.242,P=0.809,P0.05,组间临床症状积分量化差异无统计学意义。3.参照《尿酸盐结晶在手足部的沉积规律》、《尿酸盐结晶与手足部着力点的关系》中的尿酸盐结晶分组标准,分为轻、中、重三组,对三组间尿酸盐结晶沉积计数的差异性进行比较。经秩和检验分析,重度组的临床症状量化积分与轻度组有显著性差异(P0.05),中度组的临床症状量化积分与轻度组有差异(P0.05)。4.痛风患者手指特异性变化量化积分不符合正态分布,临床症状积分符合正态分布。在对患者手指变化量化积分与症状量化积分的Spearman相关分析中发现,手指变化量化积分与症状量化积分(r s=0.661 P=0.00),P0.05,统计学认为呈正相关。结论:1.痛风患者的临床表现具有多样性、复杂性的特点,其中以关节疼痛最多,其次为关节肿胀、活动受限、关节压痛、肢体麻木、肢体发凉、肢体困沉、畏寒怕冷等。2.痛风患者的临床表现与血尿酸值无相关性,血尿酸作为一个动态观察指标,血尿酸值高时其临床表现不一定很明显,血尿酸值在正常范围时也可以有明显的临床表现。3.痛风患者的临床表现与尿酸盐结晶沉积数量具有关联性,临床症状越重尿酸盐结晶沉积部位计数越多。4.痛风患者的临床表现与手指特异性变化量化积分呈正相关,说明痛风患者临床症状越重,手指特异性变化越明显。
[Abstract]:Gout is a metabolic disease caused by the disorder of purine metabolism and / or the decrease of uric acid excretion. The crystallization of urate is the pathological basis for the onset of gouty arthritis. Most of the gout patients are characterized by repeated episodes of gouty arthritis, with many sudden onset and severe pain, which greatly affect people's life. With the rapid development of the social economy, the improvement of the people's living standard and the change of the diet structure, both domestic and foreign studies have shown that the incidence of the disease is increasing year by year and the trend of young age, and it is well developed in middle-aged men and postmenopausal women. A series of complications due to gout will also increase, so the early diagnosis and treatment of gout It can effectively improve the quality of life of gout patients and minimize the harm caused by gout. In recent years, the examination of the crystallization of urate salts, the use of advanced dual source CT gout identification technology at home and abroad to carry out clinical research and analysis, and for the differential diagnosis of gout. The clinical symptoms of gout patients are few. Through clinical observation, the clinical symptoms of gout patients are joint pain, joint swelling, limited movement, joint pressure, numbness of limbs, body numbness, limb sinking, cold and cold, flush / fever, paleness of finger end, and the clinical manifestation of gout is not only the transmission of gout 'clinical manifestations. The clinical manifestations of one or more joint intense red and swollen pain in the common sense are diverse and complex. Objective: To observe and analyze the crystalline deposit of urate in the hand and foot of 193 patients with gout using the advanced dual source CT gout identification technique, to understand the main clinical manifestation, to record the symptom integral, and to crystallize its uric acid salt. The correlation between clinical symptoms and uric acid salt crystallization was observed, the relationship between clinical symptoms and uric acid in patients with gout was investigated, and the specific changes of the fingers were observed, and the correlation between the clinical symptom score and the clinical symptom score was observed. Methods: 193 cases of gout, 111 (58%) men (58%) and 82 women with diagnostic criteria were selected. For example (42%) all patients came from the peripheral blood vessel outpatient from April 2013 to August 2014. Sign informed consent, record the patient's name, sex, age, clinical symptoms, finger specific changes, parallel double source CT uric acid crystal imaging and blood uric acid value examination, observe, record the site of uric acid salt crystallization, quantity, and will be in danger. The bed symptoms, the finger specific changes were quantified, and the data were collected and processed. Results: all 1.193 patients with gout were found to have a crystalline deposit of uric acid salt, and 240 of them were found. The clinical manifestations of gout patients were the most joint pain, followed by joint swelling, limited activity and joint tenderness. .2. according to the blood uric acid group, t test, t=-16.201, P=0.000, P0.05, the difference of uric acid between the two groups was statistically significant, and the clinical symptom score of the two groups was determined by t test, t=-0.242, P=0.809, P0.05, and there was no statistically significant difference in the clinical symptoms of t=-0.242, P=0.809, and P0.05 between the group and the.3. reference < urate crystallization in hand and foot. The regularity of the deposition of the Department >, < the relationship between the urate crystallization and the hand and foot focus of the urate and the foot and the feet > the standard of the urate crystallization group, divided into three groups of light, medium and heavy, compared the difference between the three groups. By the rank sum test, the quantitative score of the clinical symptoms in the severe group was significantly different from that in the mild group (P0.05), and the moderate group Quantitative integral of clinical symptoms was different from that of mild group (P0.05), the quantitative integral of finger specific changes in.4. gout patients did not conform to normal distribution, and the integral of clinical symptoms accords with normal distribution. In the Spearman correlation analysis of quantitative integral of finger changes and quantitative integral of symptoms of the patients, the quantitative integral of finger changes and quantitative integral (R s=) were found. 0.661 P=0.00), P0.05, statistically positive correlation. Conclusion: the clinical manifestations of 1. gout patients are characterized by diversity and complexity, with the most joint pain, followed by joint swelling, limited activity, joint pressure, numbness of limbs, limb numbness, limb depression, cold and cold and cold, and the clinical manifestations of.2. gout patients and blood uric acid value Correlation, the blood uric acid is a dynamic observation index, the clinical manifestation of the blood uric acid is not necessarily obvious when the blood uric acid is high. The clinical manifestation of.3. gout patients in the normal range is also associated with the number of uric acid salt crystallization, the more the clinical symptoms, the more the urinary acid salt crystallized. 4. the clinical manifestation of gout patients is positively correlated with the finger specific change quantification score, indicating that the heavier the clinical symptoms of gout, the more obvious the finger specificity changes.
【学位授予单位】：河南中医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R589.7

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