【作者】 阮氏惠；

【导师】 刘友章；

【作者基本信息】 广州中医药大学 ， 中医内科， 2012， 博士

【摘要】 痛风(?)(gout)是由遗传性和(或)获得性原因导致尿酸排泄减少和(或)嘌呤代谢障碍的异质性疾病。其临床特点为高尿酸血症和尿酸盐结晶、沉淀所致的特征性急性关节炎、痛风石、间质性肾炎,严重者可致关节活动障碍和畸形。常伴有尿酸性尿路结石。本病主要分为原发性(primary gout)和继发性(secondary gout)两大类。原发性痛风病患具有一定的家族遗传性,大约10%-20%的患者具有阳性家族史,除大约1%的原发性痛风患者由于先天性酶缺陷引起外,大多数发病原由不明。实际上原发性痛风最为多见,且最为临床专家学者所关注。痛风属中医“痹证”、“历节”、“走注风”等范畴。近年来,随着越南居民生活水平的提高和饮食结构的改变,痛风的患病率呈上升趋势,本病的难以根治性及反复发作性,给社会及个人带来较大的痛苦和经济负担。临床上原发性痛风最为多见,且最为临床专家学者所关注。近年来,许多学者对原发性痛风的中医辨证论治及相关发病因素进行了深入研究并取得一定的成果。目的本研究通过对越南河内市公安部传统医院住院治疗痛风患者的一般情况、症状、证候、用药特点进行探讨为痛风的临床辩证论治提供理论依据和指导意义。方法本课题对2006年1月至2010年12月5年内越南河内市公安部传统医院住院确诊为痛风的住院病人(共291例)进行了临床资料全面、系统、规范、总结,包括患者的性别、年龄、出生地、病程、发病年份、发病季节、合并疾病、关节症状、全身症状、舌脉、血尿酸、中医证型、方药频数等原始数据进行了分析总结,得出具有规律性的分布特点。结果越南河内痛风患者的发病率男性远高于女性。患者的年龄分布在41-70岁之间最多,70岁之前随年龄增加而发病人数增多,发病最小年龄为30岁。病人居住地城市多于农村。在河内住院的痛风患者以2007年以后明显升高,2010年痛风住院病人最多,为87例(占29.9%)。痛风患者四季均可发病,其中以春秋季较多。患者痛风病程在1年内108例(占37.1%),1年-5年为139例(占47.8%),5年-10年为37例(占12.7%),10年以上病程者较少。发病诱因以高嘌呤饮食、饮酒为主。痛风合并疾病比率为合并高血压占101例(占37.7%),合并糖尿病52例(占17.9%),合并血脂异常症45例(占15.4%),合并冠心病21例(占7.2%)。患者血尿酸高于正常值(≥430μmol/L)共203例(占69.8%),正常值范围内(<430μmol/L)共88例(占30.2%)。疼痛部位以跖趾、踝关节为多,共176例(占60.5%),其次为：足背、膝关节、腕关节、掌指关节、肘关节等部位。全身症状中以睡眠不佳最为明显105例(占36%)。患者舌象以舌质红112例(占38.5%)、苔黄腻87例(占29.7%)最多,其次以舌淡苔薄黄等湿热象。而舌质暗红43例(占14.8%)、淡暗26例(占8.9%)、暗等血瘀表现也有不少。中医证型湿热蕴结证为主137例(占47.1%),肝肾亏虚、湿热蕴结58例(占19.9%),风湿热痹证45例(占15.4%),气滞血瘀证33例(占11.3%),风寒湿痹证13例(占4.5%),各种类型的中药应用具有交叉性,比例以利水渗湿药最多,其次为清热药、活血化瘀、补虚药、祛风湿药、化湿药等。结论1、在越南河内市住院的痛风患者以中年男性较多,有年轻化发病的趋势,患者住院季节以春秋季为多,近年来痛风发病率明显升高。2、城市地区发病率高于农村,考虑其与地理、气候、饮食、人文等有关。痛风患者合并高血压、糖尿病、血脂异常症、冠心病等疾病机率明显增多。3、关节症状表现以四肢末端关节红肿热痛为主,患者舌脉体现了湿热为主,后期伤及肝肾,最后导致气滞血瘀的病机特点。4、中医证型主要是湿热蕴结证、风湿热痹证、气滞血瘀证为主。5、越南河内市痛风患者的中医用药特点为符合辨病辨证的基础上用药,主要以利水、清热、祛湿为主,根据辨证加用补虚、活血化瘀、祛风湿、化湿等药物。更多还原

【Abstract】 Gout (gout) is caused by genetic and (or) acquired causes the excretion of uric acid to reduce and (or) purine metabolism disorders heterogeneous disease. The clinical features of high serum uric acid (hyperuricemia), and urate crystals, and precipitation caused by the characteristics of acute arthritis, tophi, interstitial nephritis, severe cases can lead to disorders and deformity of the joint activities. Often accompanied by uric acid urinary tract stones. The disease is divided into primary (primary gout) and secondary (secondary gout) two categories. With primary gout have some hereditary, and approximately10%to20%of patients had positive family history. Clinical primary gout is the most common, and most clinical experts and scholars pay close attention to. The Gout is a traditional Chinese medicine,"bi syndrome","calendar day","go note wind" and other areas. In recent years, with the improvement of domestic living standards and diet changes, gout prevalence is rising, this disease is difficult to cure and recurrent, immense suffering and economic burden to society and individuals. Primary gout is the most common clinical concern, and most clinical experts and scholars. In recent years, traditional Chinese medicine combined with the use of Western medicine epidemiological investigation, diagnosis and treatment of primary gout and related risk factors were studied and obtained a certain value.ObjectiveIn this study, Hanoi, Vietnam Ministry of Public Security traditional hospital inpatient general situation in the treatment of patients with gout, symptoms, syndromes, medication characteristics to explore, to further understanding of the regularity of gout in the contemporary environment, on gout diagnosis and treatment and better clinicaltheoretical basis and guidance. MethodsThe topics for the2010and2006, five years in Hanoi, Vietnam Ministry of Public Security traditional hospital hospital diagnosed with gout in-patients (291cases) a summary of the clinical data. According to medical records on patients’ gender, age, place of birth, duration, year of onset, season of onset, comorbidity, joint symptoms, systemic symptoms, tongue and pulse, blood uric acid situation, TCM syndromes, prescription frequency and other raw data were analyzed and summarized obtained with a regular distribution characteristicsResultsHanoi, Vietnam, in patients with gout, the incidence of males than females. The age distribution of patients between41-70years of age the most before the age of70increased with age and increased incidence of incidence of minimum age of30years. The patient residence cities than in rural areas. Gout patients hospitalized in Hanoi after2007was significantly increased, up to the gout in-patients in2010,87cases (29.9%). The incidence of gout in patients with the four seasons can be, which is more in spring and autumn. Patients with gout duration of1year,108cases (37.1%),1year5years139cases (47.8%),5years-10years,37cases (12.7%), the course of the disease were less in more than10years. Predisposing factors to the high-purine diet, alcohol-based, non-obvious incentive. Gout disease ratio of the merger accounted for101cases (37.7%) for hypertension, diabetes mellitus52cases (17.9%), dyslipidemia disease45cases (15.4%) with coronary heart disease21cases (7.2%). Serum uric acid higher than normal (≥430μmol/L), a total of203cases (69.8%), within the normal range (<430μmol/L), a total of88cases (30.2%) Pain in patients with parts of the metatarsophalangeal and ankle joints, a total of176cases (60.5%), followed by:the dorsum of the foot, knee, wrist, metacarpophalangeal joints, elbow and other parts. Systemic symptoms, poor sleep, the most obvious of105cases (36%). The tongue in patients with red tongue112cases (38.5%), yellow greasy moss87cases (29.7%) up to, followed by damp heat like a pale tongue, thin yellow and so on. The dark red tongue, while43cases (14.8%), light dark26cases (8.9%), dark blood stasis performancealso many.TCM syndromes heat accumulation card-based137cases (47.1%), liver and kidney deficiency, heat accumulation of58cases (19.9%), wind heat and moisture arthralgia45cases (15.4%), qi stagnation33cases (11.3%), the wind cold dampness arthralgia13cases (4.5%), various types of traditional Chinese medicine applications with cross-proportion to the benefits of water wetting drug, followed by antipyretic, promoting blood circulation stasis, tonic medicine, rheumatism medicine, dampness drugs.Conelusion1、Hanoi Vietnam Ministry of Public Security traditional hospital patients with gout in middle-aged men more, at a younger age trend of the incidence of hospitalization time in spring and autumn, a significantly higher incidence of gout in recent years.2、City area more incidence, considering its geography and climate, diet, the humanities and other relevant. Gout patients complicated with hypertension, diabetes, dyslipidaemia, coronary heart disease increased significantly.3、The joint symptoms consisting mainly of the extremities, joint pain, swelling, tongue and pulse of patients reflects the hot and humid, late injuries to the liver and kidney, and finally lead to blood stasis pathogenesis characteristics.4、Syndromes of traditional Chinese medicine is mainly wet-hot certificate and rheumatic fever, arthralgia, heat and blood stasis syndrome mainly to block.5、Hanoi Vietnam Ministry of Public Security traditional hospital, TCM drugs in patients with gout is characterized by:comply with the medication on the basis of the identified syndrome differentiation, mainly to facilitate water, heat, dampness mainly dialectical plus with tonic, blood circulation, rheumatism, dampness, and other drugs.更多还原