1、0.05)。D14与对照组比较,IL-6、IL-18表达水平均明显升高(P观察组内比较:D0与D3相比,IL-1、IL-18表达水平均明显升高,差异均有统计学意义(P0.01)。D0与D7相比,IL-1、IL-18、TNF-表达水平均明显升高,差异均有统计学意义(PD0与D14相比,IL-1、IL-6、IL-18、TNF-表达水平均明显升高,差异均有统计学意义(PD3与D7相比,IL-1、IL-18、TNF-表达水平均明显升高,差异均有统计学意义(P0.01),IL-6表达水平明显升高,差异有统计学意义(PD3与D14、D7与D14相比,IL-1、IL-6、IL-18、TNF-表达水平均明显升
2、高,差异均有统计学意义(P结论:血清IL-1、IL-6、IL-18及TNF-水平在AGA患者镇痛治疗过程中表达异常,提示其在AGA发病中参与了炎症反应过程,在炎症机制中可能发挥了重要作用。【关键词】 白细胞介素-1; 白细胞介素-6; 白细胞介素-18; 肿瘤坏死因子-; 痛风性关节炎 【Abstract】 Objective:To study the changes of serum interleukin(IL)-1,IL-6,IL-18 and tumor necrosis factor(TNF)- of patients with acute gouty arthritis (AGA)
3、 in analgesic treatment process,and the roles of them in pathogenesis in AGA.Method:According to the standards of American College of Rheumatology (ACR) in 1997, 100 outpatients who had acute gouty arthritis (AGA) were selected as test group (T),all patients came from our hospital from August 2014 t
4、o February 2016.At the same time,100 healthy subjects were selected as control group (C) who were local residents of Qingdao came from Health Examination Center of our hospital.Serum level of IL-1,IL-6,IL-18 and TNF- were measured by using Enzyme-linked immunosorbent assay (ELISA) in the two groups.
5、All proinflammatory cytokines were compared between T and C.T consisted of four stages of disease process:pretherapy (D0),3rd day after medications (D3),7th day after medications (D7) and 14th day after medications (D14).Result:D0,D3,D7 of the T compared with C,the levels of IL-1,IL-6,IL-18,TNF- wer
6、e rised(P0.05).IL-6,IL-18 were rised too at D14 in the T,compared with C(P0.05).The serum levels of IL-1 and IL-18 increased significantly when D0 compared to D3(P0.01).There was significant difference of serum level of IL-1,IL-18 and TNF- in D0 when compared to D7(P0.01).The level of IL-1,IL-6,IL-1
7、8 and TNF- increased significantly when D0 compared to D14(P0.01).The level of IL-1, IL-18 and TNF- increased significantly when D3 compared to D7(P0.01) and IL-6(P0.05).When D3 and D7 compared to D14,the level of the four inflammatory cytokines all increased significantly(P420 mol/L,绝经前女性360 mol/L,
8、绝经后女性的诊断标准同男性。两组研究对象性别、年龄比较差异均无统计学意义(P本研究得到本院伦理委员会批准,所有研究对象均知情同意。1.2 治疗方案 AGA发病时的一线镇痛药物包括非甾体类消炎药(NSAIDs)、COX-2抑制剂、秋水仙碱或类固醇药物3,首选秋水仙碱及NSAIDs4,通过降低患者血清及关节液中IL-1、TNF-、环氧化酶-2等的水平发挥作5。观察组治疗方案:在低嘌呤饮食、足量饮水前提下,给予:(1)镇痛:为主要治疗措施。秋水仙碱片(西双版纳版纳药业有限责任公司,国药准字:H53021369;批号:140109;有效期:36个月),服药疗程14 d:前3 d 0.5 mg/次,3次
9、/d,餐后服;然后0.5 mg/次,2次/d,餐后服,连续用药7 d;后4 d 0.5 mg/次,1次/晚,睡前服。依托考昔片(安康信,Merck Sharp & Dohme Corp;分包装企业名称:杭州默沙东制药有限公司;进口药品注册证号:注册证号H20130299;批准文号:国药准字J20130133;Y1981,有效期:2014.03.14-2017.03.13)6-9,服药疗程10 d:前3 d 120 mg/次,1次/d,餐后服;3 d后60 mg/次,1次/d,餐后服,连续用药7 d。(2)碱化尿液:抑制尿酸在肾脏形成晶体,促进尿酸肾脏排泄。尿pH值维持在6.26.8。给予口服枸
10、橼酸钾钠颗粒(逍适柠,武汉维奥制药有限公司,国药准字H20103086;产品批号:20150501;有效期至:2016/04)2.5 g/次,4次/d(三餐后及睡前)。治疗过程中若出现肝、肾功能异常及胃肠道反应则予以排除。1.3 观测指标 1.3.1 测定两组的一般生理指标 年龄(Age)、身高(BH)、体重(BW)、收缩压/舒张压(SBP/DBP)、腰围(WC)、臀围(HC)。计算腰臀比(WHR)及体质量指数(BMI)。BMI=体重(kg)/身高(m2)。1.3.2 测定两组的生化指标 空腹血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿酸(UA)、空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-
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