以持续性中、高热为首要表现的痛风急性发作1例报告及文献复习

doi:10.13481/j.1671-587x.20190343

摘要/Abstract

摘要： 目的：分析以持续性中、高热为首发症状的痛风急性发作患者的临床诊治方法，以提高临床医生对以持续性中、高热为首要表现的痛风急性发作的认识。方法：收集1例不明原因发热老年男性患者的临床资料，并结合文献复习，探讨该病的诊断和治疗方法。结果：患者以"持续性发热4d"入院，血常规检查示白细胞计数明显升高，胸部CT示左肺下叶炎症，给予积极抗感染治疗10 d，患者发热症状无明显缓解，白细胞计数仍明显高于正常水平，全面的实验室检查和影像学检查均未见引起发热的阳性结果。患者查体见双足痛风结节，血尿酸水平明显升高，结合患者既往痛风病史，给予试验性抗痛风治疗；治疗2周后，患者发热症状逐渐缓解，白细胞计数和尿酸水平逐渐恢复正常，考虑发热原因为痛风急性发作。结论：对于不明原因发热，尤其是中、高度热型患者，如系统抗感染治疗效果不好，应考虑痛风急性发作。

关键词: 痛风, 发热, 痛风性关节炎, 病例报告

Abstract: Objective:To analyze the diagnosis and treatment methods of one acute gout attack patient with persistent medium and high fever as the first manifestation, and to improve the understanding of the clinicians for acute gout attack with persistent medium and high fever as the first manifestation. Methods:The cliniccal data of an elderly male patient with fever of unknown cause was collected; the literature review was perfomed and the diagnosis and treatment methods of the disease were explored. Results:The patient was admitted to hospital because of persistent fever for 4 d. The count of white blood cells in the routine blood test was high and the left lower lobe inflammation was found in the chest CT scanning. The patient was given the active anti-infection treatment for 10 d,but there was no obvious relief of fever manifestation, and the count of white blood cells remained the high level; no positive results inducing fever were found through comprehensive laboratory examinations and imageological examination. The gout nodules on both feet of the patient were found by physical examination and the level of uric acid was high, so the patient was given experimental anti-gout treatment combined with his previous history of gout. The patient's fever manifestation gradually relieved, the count of white blood cells in routine blood test and the level of uric acid were gradually decreased to the normal levels. The acute gout attack was considered as the cause of fever. Conclusion:For the patients with fever of unknown cause, especially with medium and high fever, if the systematic anti-infection treatment is not effective,the possibility of acute gout attack should be considered.

Key words: gout, fever, gouty arthritis, case report

中图分类号:

R589.7

田畅, 刘伽莹, 丛珊, 赵敏, 王珂. 以持续性中、高热为首要表现的痛风急性发作1例报告及文献复习[J]. 吉林大学学报(医学版), 2019, 45(03): 714-717.

TIAN Chang, LIU Jiaying, CONG Shan, ZHAO Min, WANG Ke. Acute gout attack with persistent medium and high fever as first manifestation: A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2019, 45(03): 714-717.

参考文献

[1] 李聪,廖立宏.83例原发性痛风临床分析[J].中国保健营养:上旬刊, 2014,24(7):3940-3941.
[2] KATO M, OISHI Y, INADA M, et al.Advanced erosive gout as a cause of Fever of unknown origin[J]. Korean J Fam Med, 2015,36(3):146-149.
[3] 路杰,崔凌凌,李长贵.原发性痛风流行病学研究进展[J].中华内科杂志,2015,54(3):244-247.
[4] 高小娟,陈仁利,宋一凡.原发性痛风的临床特点和流行病学研究[J].中国卫生标准管理,2018,9(14):15-17.
[5] EMILIO B Gonzalez. An update on the pathology and clinical management of gouty arthritis[J]. Clin Rheumatol, 2012, 31(1):13-21.
[6] 靳京美.痛风与高尿酸血症的发病原因及诊治分析[J].中国现代药物应用,2010,4(24):49-50.
[7] 沙燕.痛风疾病的临床表现及自我护理[J].云南科技管理,2014,27(5):64-65.
[8] BRUCE N, PRASHANTH S. Mechanistic aspects of inflammation and clinical management of inflammation in acute gouty arthritis[J]. J Clin Rheumatol, 2013, 19(1):19-29.
[9] MARTIN W J, WALTON M, HARPER J. Resident macrophages initiating and driving inflammation in a monosodium urate monohydrate crystal-induced murine peritoneal model of acute gout[J]. Arthritis Rheum, 2009, 60(1):281-289.
[10] 李颖,吴振彪,符向辉,等.痛风的临床病理特征分析并文献复习[J].现代生物医学进展,2016, 16(27):5250-5253,5279.
[11] NEOGI T,JANSEN TL,DALBETH N, et al.2015 Gout classification criteria:an American College of Rheumatology/European League Against Rheumatism Collaborative Initiative[J].Ann Rheum Dis, 2015, 74(10):1789-1798.
[12] BAKER J F, SCHUMACHER H R. Update on gout and hyperuricemia[J]. Int J Clin Pract, 2010, 64(3):371-377.
[13] RICHETTE P, DOHERTY M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout[J]. Ann Rheum Dis, 2017, 76(1):29-42.
[14] 李美友,蔡巧敏.加味四物汤联合苯溴马隆治疗痛风病30例[J].中国中医药现代远程教育,2013,11(23):57.
[15] 郝燕捷,周炜,樊勇,等.表现为多关节炎高热伴血白细胞异常增多的罕见痛风一例[J].中华风湿病学杂志,2015,19(11):770-772.
[16] 赵星,刘涛.痛风性多关节炎伴高热循证医学指导下的诊断治疗[J].实用医药杂志,2018, 35(6):510-514.
[17] 李君蕊,姜晖,何国莉,等.372例不明原因发热病因分析研究[J].中国全科医学,2018,21(15):1882-1885.
[18] KHANNA D, FITZGERALD J D, KHANNA P P, et al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1:Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia[J]. Arthritis Care Res (Hoboken), 2012, 64(10):1431-1446.
[19] 吴华香.美国风湿病学会痛风治疗指南解读[J].浙江医学,2014,36(2):92-93.
[20] 邹和建,姜林娣.2012年美国风湿病学会痛风治疗指南评析[J].内科理论与实践,2012,7(6):458-460.
[21] 阚民强,刘欣,杨润华.以意识障碍就诊的老年发热患者误漏诊分析[J].临床误诊误治,2011,24(11):54-55.