痛风急性期开始降尿酸治疗对临床疗效影响的Meta分析-现代医学

痛风急性期开始降尿酸治疗对临床疗效影响的Meta分析

单位：1. 川北医学院临床医学院, 四川南充 637000;
2. 成都医学院临床医学院, 四川成都 610500;
3. 宜宾市第一人民医院风湿免疫科, 四川宜宾 644000

分类号：R589.7

出版年·卷·期（页码）：2024·52·第七期（1070-1077）

摘要：

目的：通过Meta分析评估在痛风急性期开始降尿酸治疗对痛风急性发作的持续时间、疼痛程度、炎症指标、痛风的复发率、降尿酸治疗的依从性和安全性等方面的影响。方法：计算机检索中国生物医学文献服务系统、中国知网、万方数据服务平台、PubMed、Web of Science、Cochrane library、EMBase数据库中比较痛风急性期开始降尿酸治疗(试验组)与痛风急性发作缓解后开始降尿酸治疗(对照组)对临床疗效影响的随机对照试验，检索时限为建库至2023年12月，由两名研究者独立筛选文献、提取数据并进行文献质量评价，采用RevMan 5.3软件进行Meta分析。结果：共纳入12篇文献，包括1 000例患者。Meta分析结果显示，试验组与对照组患者痛风的持续时间(SMD=-0.06，95%CI -0.62～0.50，P=0.82)，治疗后的疼痛视觉模拟评分(第3天：MD=0.07，95%CI -0.19～0.34，P=0.60；第7天：MD=-0.10，95%CI -0.34～0.13，P=0.38)，炎症指标(C反应蛋白：MD=-1.35，95%CI -3.57～0.87，P=0.23；血沉：MD=-1.71，95%CI -4.24～0.81，P=0.18)，痛风的复发率(第1个月：RR=1.19，95%CI 0.68～2.07，P=0.54；第3个月：RR=0.83，95%CI 0.55～1.25，P=0.37；第6个月：RR=0.87，95%CI 0.49～1.53，P=0.63)和不良反应的发生率差异均无统计学意义，试验组患者降尿酸治疗的依从性要优于对照组(RR=1.40，95%CI 1.18～1.65，P＜0.001)。结论：在抗炎镇痛的背景治疗下，痛风急性期开始降尿酸治疗不会延长痛风的持续时间、加重关节的疼痛程度、影响关节炎症的消退，也不会增加痛风的复发率及不良反应的发生率，并且可能会增加患者降尿酸治疗的依从性，但也需要更高质量的研究来继续验证这一结论。

Objective: To evaluate the effect of initiating urate-lowering therapy during an acute gout attack on the duration, pain degree, inflammatory indicators, recurrence rate of gout flares, the adherence of urate-lowering therapy and safety by Meta-analysis. Methods: Randomized controlled trials to compare the effect of initiating urate-lowering therapy during an acute gout attack(experimental group) and after an acute gout attack(control group) were retrieved from SinoMed, CNKI, Wanfang Data, PubMed, Web of Science, Cochrane library and EMBase. The retrieval time was from the establishment of the database to December 2023. Two researchers independently retrieved literatures, extracted data, and evaluated the quality of all included literatures. RevMan5.3 software was used for data analysis. Results: A total of 12 studies with 1 000 patients were included. The results of Meta-analysis showed that there were no significant differences in the duration of acute gout attacks(SMD=-0.06, 95%CI -0.62-0.50, P=0.82), the pain visual analogue score(day 3:MD=0.07, 95%CI -0.19-0.34, P=0.60;day 7:MD=-0.10, 95%CI -0.34-0.13, P=0.38), the C-reactive protein(MD=-1.35,95%CI -3.57-0.87,P=0.23), the erythrocyte sedimentation rate(MD=-1.71,95%CI -4.24-0.81,P=0.18),the recurrence rate of gout flares(1 month: RR=1.19,95%CI 0.68-2.07,P=0.54; 3 months: RR=0.83, 95%CI 0.55-1.25,P=0.37;6 months: RR=0.87, 95%CI 0.49-1.53, P=0.63) and the incidence of adverse effects between two groups. The adherence of the experimental group was better than that of the control group(RR=1.40, 95%CI 1.18-1.65,P＜0.001). Conclusion: With anti-inflammatory and analgesic therapy, initiating urate-lowering therapy during an acute gout attack will not prolong the duration, aggravate the degree of joint pain, or affect the resolution of joint inflammation. Furthermore, it will not increase the recurrence rate of gout flares and the incidence of adverse events. Additionally, initiating urate-lowering therapy during an acute gout attack may also increase the patients' adherence to urate-lowering therapy, although higher quality studies are needed to verify this conclusion.

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