本文選題：痛風(fēng) + 臨床癥狀��； 參考：《河南中醫(yī)學(xué)院》2015年碩士論文

【摘要】：痛風(fēng)是由于嘌呤代謝紊亂及/或尿酸排泄減少所引起的一種代謝性疾病,尿酸鹽結(jié)晶沉積是誘發(fā)痛風(fēng)性關(guān)節(jié)炎發(fā)作的病理基礎(chǔ),大多數(shù)痛風(fēng)患者臨床表現(xiàn)為痛風(fēng)性關(guān)節(jié)炎的反復(fù)發(fā)作,且多驟然發(fā)作并伴劇烈疼痛,極為影響人們的生活。隨著社會(huì)經(jīng)濟(jì)的飛速發(fā)展,人民生活水平的提高,飲食結(jié)構(gòu)的變化,目前國(guó)內(nèi)外研究均表明其發(fā)病率呈逐年升高并年輕化的趨勢(shì),且好發(fā)于中年男性及絕經(jīng)后女性。因痛風(fēng)所致一系列并發(fā)癥也將隨之增多,因此對(duì)痛風(fēng)的早期診斷及治療可有效提高痛風(fēng)患者的生活質(zhì)量,盡可能的降低痛風(fēng)所帶來(lái)的危害。近年來(lái)對(duì)尿酸鹽結(jié)晶的檢查,國(guó)內(nèi)外采用先進(jìn)的雙源CT痛風(fēng)識(shí)別技術(shù)開(kāi)展臨床研究與分析,并用于痛風(fēng)的鑒別診斷,但國(guó)內(nèi)外的研討多圍繞急性痛風(fēng)性關(guān)節(jié)炎發(fā)作期進(jìn)行,對(duì)痛風(fēng)患者臨床癥狀多樣性的資料尚少。本研究通過(guò)臨床觀察,痛風(fēng)患者臨床癥狀表現(xiàn)為關(guān)節(jié)疼痛、關(guān)節(jié)腫脹、活動(dòng)受限、關(guān)節(jié)壓痛、肢體麻木、肢體發(fā)涼、肢體困沉、畏寒怕冷、關(guān)節(jié)潮紅/發(fā)熱、指端蒼白等,可見(jiàn)痛風(fēng)的臨床表現(xiàn)不單單是傳統(tǒng)意識(shí)上的單個(gè)或多個(gè)關(guān)節(jié)劇烈的紅腫熱痛,其臨床表現(xiàn)具有多樣性、復(fù)雜性。目的:采用先進(jìn)的雙源CT痛風(fēng)識(shí)別技術(shù),對(duì)193例痛風(fēng)患者手足部位尿酸鹽結(jié)晶沉積進(jìn)行觀察分析,了解其主要臨床表現(xiàn),記錄其癥狀積分,并對(duì)其尿酸鹽結(jié)晶進(jìn)行影像學(xué)分級(jí),觀察臨床癥狀與尿酸鹽結(jié)晶沉積的關(guān)聯(lián)性;探討痛風(fēng)患者臨床癥狀與血尿酸之間的關(guān)系;觀察手指特異性變化,并將其量化,觀察臨床癥狀積分與其之間的關(guān)聯(lián)性。方法:選取符合診斷標(biāo)準(zhǔn)的痛風(fēng)病人193例,男111例(58%),女82例(42%),所有病人均來(lái)自于2013年4月至2014年8月周?chē)芸崎T(mén)診病人。簽署知情同意書(shū),詳細(xì)記錄患者姓名、性別、年齡、臨床癥狀、手指特異性變化等,并行雙源CT尿酸鹽結(jié)晶成像及血尿酸值檢查,觀察、記錄尿酸鹽結(jié)晶沉積部位、數(shù)量,并將臨床癥狀、手指特異性變化進(jìn)行量化,整理所得數(shù)據(jù)并對(duì)其作統(tǒng)計(jì)學(xué)處理。結(jié)果:1.193例痛風(fēng)患者中均發(fā)現(xiàn)尿酸鹽結(jié)晶沉積,共統(tǒng)計(jì)雙手足尿酸鹽結(jié)晶沉積部位240個(gè)。痛風(fēng)患者臨床表現(xiàn)以關(guān)節(jié)疼痛最多,其次為關(guān)節(jié)腫脹、活動(dòng)受限、關(guān)節(jié)壓痛、肢體麻木、肢體發(fā)涼等。2.根據(jù)血尿酸分組,兩組間血尿酸值經(jīng)t檢驗(yàn),t=-16.201,P=0.000,P0.05,組間血尿酸差異有統(tǒng)計(jì)學(xué)意義;兩組間臨床癥狀積分經(jīng)t檢驗(yàn),t=-0.242,P=0.809,P0.05,組間臨床癥狀積分量化差異無(wú)統(tǒng)計(jì)學(xué)意義。3.參照《尿酸鹽結(jié)晶在手足部的沉積規(guī)律》、《尿酸鹽結(jié)晶與手足部著力點(diǎn)的關(guān)系》中的尿酸鹽結(jié)晶分組標(biāo)準(zhǔn),分為輕、中、重三組,對(duì)三組間尿酸鹽結(jié)晶沉積計(jì)數(shù)的差異性進(jìn)行比較。經(jīng)秩和檢驗(yàn)分析,重度組的臨床癥狀量化積分與輕度組有顯著性差異(P0.05),中度組的臨床癥狀量化積分與輕度組有差異(P0.05)。4.痛風(fēng)患者手指特異性變化量化積分不符合正態(tài)分布,臨床癥狀積分符合正態(tài)分布。在對(duì)患者手指變化量化積分與癥狀量化積分的Spearman相關(guān)分析中發(fā)現(xiàn),手指變化量化積分與癥狀量化積分(r s=0.661 P=0.00),P0.05,統(tǒng)計(jì)學(xué)認(rèn)為呈正相關(guān)。結(jié)論:1.痛風(fēng)患者的臨床表現(xiàn)具有多樣性、復(fù)雜性的特點(diǎn),其中以關(guān)節(jié)疼痛最多,其次為關(guān)節(jié)腫脹、活動(dòng)受限、關(guān)節(jié)壓痛、肢體麻木、肢體發(fā)涼、肢體困沉、畏寒怕冷等。2.痛風(fēng)患者的臨床表現(xiàn)與血尿酸值無(wú)相關(guān)性,血尿酸作為一個(gè)動(dòng)態(tài)觀察指標(biāo),血尿酸值高時(shí)其臨床表現(xiàn)不一定很明顯,血尿酸值在正常范圍時(shí)也可以有明顯的臨床表現(xiàn)。3.痛風(fēng)患者的臨床表現(xiàn)與尿酸鹽結(jié)晶沉積數(shù)量具有關(guān)聯(lián)性,臨床癥狀越重尿酸鹽結(jié)晶沉積部位計(jì)數(shù)越多。4.痛風(fēng)患者的臨床表現(xiàn)與手指特異性變化量化積分呈正相關(guān),說(shuō)明痛風(fēng)患者臨床癥狀越重,手指特異性變化越明顯。
[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.
【學(xué)位授予單位】：河南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R589.7

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