Observation On Standard Therapeutic Effect Of Double Drug Combined Therapy Of Refractory Gout

Background: Several years after repeated attacks of gouty arthritis,chronic multiple and destructive arthritis accompanied would be occurred with gouty stone formation and/or uric acid kidney stones.Under these circumstances,routine dosage is difficult to make blood uric acid up to the standard,that is,refractory gout,which has clinical characteristics such as urate deposition,gout stone formation,joint deformity,renal insufficiency,hypertension,diabetes and coronary heart disease.Thoes complications bring tremendous pain to patients and affect the quality of life and life expectancy.The experts on the treatment of hyperuricemia and gout suggests that the combination of hypouric acid drugs should be considered for the treatment of refractory gout.Aims: To provide reference and suggestions for the clinical medication of refractory gout and hyperuricemia,by observing the therapeutic effect,effective dosage and adverse reactions of combined therapy of two drugs in treating refractory gout.Methods: 1.Collecte the medical records of all patients with gouty arthritis from February 2016 to September 2018 in Subei People's Hospital,screening the eligible case data by inclusion criteria and exclusion criteria;2.Divede the Sixty-two patients into three groups according to the treatment plan: allopurinol + benzbromarone group(group A),benzbromarone + februsta group(group B),allopurinol + februsta group(group C),and record the monthly blood uric acid,blood routine,transaminase,creatinine and uric acid values.Record the urate deposition concentration which was detected by dual-source CT at the site of gout attack before and after treatment,and record the dosage changes during treatment,and adverse reactions occurred during treatment.3.Retrieval data from MEDLINE,The Cochrane Library,EMBASE,CNKI,CBM and Vip databases,supplemented by manual searches and literature retrospective methods,collecting the large-scale randomized controlled trials of allopurinol,phenylbromarone and febupropath in the treatment of hyperuricemia in Asian population from 2005 to 2016.According to the inclusion criteria,the experimental data were statistically sorted out,and the standard dose,standard rate and incidence of serious adverse reactions of three single drugs in the treatment of gout were calculated.The data related to this study were statistically analyzed.4.Make Statistical analysis of the research data: data were processed by SPSS 23.0 software package,and the general data were expressed by X±S.Normality test and homogeneity test of variance were used for normal data.T test was used for comparison between normal data groups.Mean test was used for comparison between two groups of measurement data.Variance analysis was used for comparison of multiple samples.The utilization rate of counting data was expressed by X2 test.The difference was statistically significant(P < 0.05).Results: 1.The serum uric acid level of 62 patients in the three groups decreased to below 360 mmol/L after one month of treatment,of which 60 patients maintained the standard status during six months of treatment,2 patients showed elevated serum uric acid level during treatment,and 2 patients showed elevated aminotransferase levels.2.There were significant differences in the serum uric acid level between the three groups before and after six months of treatment.There was no significant difference in serum uric acid levels among the three groups.3.By dual-source CT examination,there was no significant difference in uric acid crystallization concentration between the three groups before and after treatment.The average uric acid crystallization concentration of 62 patients before and after treatment was 1193 mg/cm^ 3,1178 mg/cm^ 3,respectively,and the difference was statistically significant.4.Compared with the data of single drug treatment in literature,the incidence of adverse reactions in the course of double drug combination therapy has a decreasing trend,and there is no significant difference.5.The continuous standard dose of double drug combination therapy is lower than that of single drug,and the cost of drug use is partly lower than that of single drug treatment.Conclusions: 1.For patients with refractory gout,the combination of two drugs has good efficacy and safety;2.Continuous low uric acid condition is beneficial to dissolution and reabsorption of uric acid crystals deposited in tissues;3.For patients with refractory gout,the dosage of the combination of two drugs is lower than that of single drug treatment,the incidence of adverse reactions tends to decrease,and the costs are also cheaper.