利尿剂诱发痛风关节炎发作的现状

        摘要（荷兰）  目的  系统综述利尿剂与发生痛风关节炎风险之间相关性的研究文献。

        方法  采用关键词和主要主题词“利尿剂、副作用和痛风”检索PubMed (1950年到2009年10月)、Embase (1974到2009年10月)和Cochrane图书馆(截止到 2009年10月)数据库，同时采用“最佳证据组合”技术。与未使用利尿剂相比，评价用利尿剂发生痛风关节炎的频率、绝对或相对风险、风险比或比值比。所有文献均为英文发表。采用荷兰Cochrane 中心的Checklists评价随机对照试验、队列研究和病例对照研究的质量。

        结果: 总共有2项随机对照研究、6项队列研究和5项病例对照研究满足入选标准。总体研究质量中等。一项RCT研究发现，与安慰剂相比，使用苄氟噻嗪（bendrofluazide）发生痛风的比值比为11.8 (95% CI 5.2-27.0)，另一项RCT研究发现，与安慰剂相比，用氢氯噻嗪（hydrochlorothiazide）加氨苯蝶啶（triamterene ）发生痛风的比值比为6.3 (95% CI 0.8-51)。三项队列研究和4项病例对照研究也发现，与未使用者相比，使用利尿剂发生痛风关节炎的风险明显增高。

        结论:用袢利尿剂和噻嗪类利尿剂的患者发生急性痛风关节炎的风险增高，但增高幅度和独立性不同，故该综述结果尚不支持痛风关节炎者停止这些有用药。

        附原文  Abstract  OBJECTIVE: To systematically review the literature investigating the relationship between use of diuretics and the risk of gouty arthritis. METHODS: PubMed (1950-October 2009), Embase (1974-October 2009), and the Cochrane Library (up to October 2009) were searched using keywords and MeSH terms diuretics, adverse effects, and gout. For this review, the technique of "best evidence synthesis" was used. Studies reporting frequency, absolute or relative risks, odds ratio, or rate ratio of gouty arthritis in diuretic users compared with nonusers were selected and evaluated. Studies had to be published in English. Checklists from the Dutch Cochrane Centre were used to assess the quality of randomized controlled trials (RCTs), cohort, and case-control studies.RESULTS: Two RCTs, 6 cohort studies, and 5 case-control studies met the inclusion criteria. The overall quality of the studies was moderate. In a RCT the rate ratio of gout for use of bendrofluazide vs placebo was 11.8 (95% CI 5.2-27.0). The other RCT found a rate ratio of 6.3 (95% CI 0.8-51) for use of hydrochlorothiazide plus triamterene vs placebo. Three cohort studies and 4 case-control studies found higher risks of gouty arthritis in users compared with nonusers of diuretics. CONCLUSIONS: There is a trend toward a higher risk for acute gouty arthritis attacks in patients on loop and thiazide diuretics, but the magnitude and independence is not consistent. Therefore, stopping these useful drugs in patients who develop gouty arthritis is not supported by the results of this review.

        引自：Hueskes BA, Roovers EA, Mantel-Teeuwisse AK, Janssens HJ, van de Lisdonk EH, Janssen M. Use of Diuretics and the Risk of Gouty Arthritis: A Systematic Review. Semin Arthritis Rheum. 2012 Jan 3. [Epub ahead of print]