壹生资讯-2020 美国痛风指南：颠覆认知的 8 个要点

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2020 美国痛风指南：颠覆认知的 8 个要点

2019-11-21作者：论坛报小塔资讯

痛风

来源：优医邦公众号

在 11 月 13 日结束的美国风湿年会上，发布了 2020 痛风临床实践指南（草案），余金泉副主任医师第一时间在现场，对更新的要点进行了全面介绍。

其中有不少推荐让人大跌眼镜，如：急性期推荐降尿酸治疗、反对碱化尿液等，下面我们整理了 8 个主要的更新要点。
新版指南将于 2020 年初正式公布，小编会持续跟进。

1. 急性期就开始降尿酸治疗
只要具有降尿酸治疗的指征，有条件推荐发作期间就应开始降尿酸治疗，而不是等急性发作缓解后再开始。

2. 推荐无限期使用降尿酸治疗药物
相对于停药，更推荐无限期使用降尿酸治疗药物。以往无论患者还是医生都对是否需要长期降尿酸治疗持怀疑态度，而本版指南终于明确，疗程就是没有疗程。

3. 反对查尿液尿酸水平，反对碱化尿液治疗

4. 秋水仙碱不要按说明书用

如果选择使用秋水仙碱，不推荐中国药物说明书推荐的用法，强烈推荐选择低剂量秋水仙碱（如 0.5 mg，tid），而不是大剂量的秋水仙碱，在有一致治疗作用的前提下不良反应大大降低。

5. 降尿酸治疗一线用药推荐
慢性肾脏病 CKD3 期以上者，强烈推荐选择黄嘌呤氧化酶抑制剂(XOI)-别嘌醇或非布司他，而不选择促尿酸排泄药物（丙磺舒）。

6. 限制高果糖玉米糖浆摄入
限制酒精和高嘌呤饮食接受度较高，限制高果糖玉米糖浆摄入应受到更大的重视。

7. 反对维生素 C 补充剂

无论疾病活动情况，反对维生素 C 补充剂应用。

8. 推荐亚裔人群使用别嘌醇前进行 HLA-B*5801 基因检测，排除携带者（约为 7.4%），以减少严重药物不良反应的发生。

注：本文根据余金泉医生介绍文章整理。

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