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作者：Rainer TH 翻译：北医三院 武东(misswudong@163.com) 审校：北医三院 金银姬 摘要 背景：近期2项双盲随机对照研究（RCTs）显示口服激素和非甾体抗炎药对痛风有相似的镇痛效果，但是研究的样本量小，并有其他的方法局限性。 目的：比较口服泼尼松龙与口服消炎痛治疗因急性痛风就诊于急诊（EDs）的患者的有效性和安全性。 设计：多中心，双盲，随机对照研究。患者被随机分为（1:1比例）消炎痛组或泼尼松龙组。（Iclass='imglazyload' srcTN45724113）。部门：香港的4个急诊部。对象：416例18岁以上的患者。测量：镇痛效果被定义为在100mm视觉模拟评分中疼痛改变（静止或活动时）大于13mm。疼痛评分测量在入急诊2小时内，及1到14天进行。 结果：376位患者完成了研究。吲哚美辛组和泼尼松龙组患者表现为相似的疼痛缓解程度，急诊阶段平均疼痛评分大约下降10mm[静息]和20mm[活动]，第1到14天时下降约25mm[静息]和45mm[活动]。研究中没有严重不良事件发生。在急诊阶段，吲哚美辛组有更多的轻微副作用（19% VS 6%，P 结论：口服泼尼松龙和消炎痛治疗急性痛风有相似的镇痛效果。泼尼松龙是治疗急性痛风的一种安全，有效的一线药物。 附原文：Abstract BACKGROUND:Two recent double-blind, randomized, controlled trials (RCTs) showed that oral steroids and nonsteroidal anti-inflammatory drugs have similar analgesic effectiveness for management of gout, but the trials had small sample sizes and other methodological limitations.OBJECTIVE:To compare the effectiveness and safety of oral prednisolone versus oral indomethacin in patients presenting to emergency departments (EDs) with acute gout.DESIGN:Multicenter, double-blind, randomized equivalence trial. Patients were randomly assigned (1:1 ratio) to receive either indomethacin or prednisolone. (Iclass='imglazyload' srcTN registry number: Iclass='imglazyload' srcTN45724113).SETTING:Four EDs in Hong Kong.PARTICIPANTS:416 patients aged 18 years or older. MEASUREMENTS:Analgesic effectiveness was defined as changes in pain (at rest or with activity) greater than 13 mm on a 100-mm visual analogue scale. Outcomes were measured during the first 2 hours in the ED and from days 1 to 14.RESULTS:376 patients completed the study. Equivalent and clinically significant within-group reductions in mean pain score were observed with indomethacin and prednisolone in the ED (approximately 10 mm [rest] and 20 mm [activity]) and from days 1 to 14 (approximately 25 mm [rest] and 45 mm [activity]). No major adverse events occurred during the study. During the ED phase, patients in the indomethacin group had more minor adverse events than those in the prednisolone group (19% vs. 6%; P 引自：Rainer TH, Cheng CH, Janssens HJ,et al. Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial. Ann Intern Med. 2016 Apr 5;164(7):464-71. |
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