张欢 甘建平 吴斌

    [摘要] 2020年1月8日重庆市中医院收治1例33岁男性诊断为难治性痛风，并发症较多。予以小剂量激素和非甾体类抗炎药口服、局部关节腔灌注治疗及重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(益赛普)皮下注射后效果不佳，改为大剂量激素静脉滴注治疗病情缓解。5 d后患者再发高热，无关节肿痛，发现患者肛周脓肿，予局部穿刺抽脓和抗生素静滴抗感染治疗，患者住院19 d症状缓解出院。对该病例进行总结分析，提示难治性痛风的治疗时当一线药物常规剂量无效时，可尝试大剂量治疗，同时管理并发症亦尤为重要。

    [关键词] 痛风;营养和代谢性疾病;发热;糖皮质激素

    [Abstract] On January 8， 2020， a 33-year-old man was admitted to Chongqing Traditional Chinese Medicine Hospital and was diagnosed as refractory gout with many complications. He was given oral administration of low-dose hormone and non-steroidal anti-inflammatory drugs， local joint cavity perfusion therapy and subcutaneous injection of recombinant human tumor necrosis factor receptor type Ⅱ-antibody fusion protein(Yisaipu). He had little effect and changed to high-dose hormones intravenous drip treatment. His condition has been relieved. Five days later， the patient recurred high fever without joint swelling and pain. The patient was found to have a perianal abscess. He was treated with local puncture and pus and intravenous antibiotics for anti-infection treatment. The patient was discharged from the hospital after 19 days. A summary analysis of this case suggested that in the treatment of refractory gout ......