哪些药物会引起痛风发作
随着生活方式的改变,饮食结构的变化,痛风患者越来越多。但也有不少痛风的发生与某些药物的使用密切相关,久用这些药物需定期化验血尿酸的浓度,及时调整药物的使用,预防痛风的发生。常见的可诱发痛风的药物包括:
利尿剂
呋塞米和氢氯噻嗪等利尿剂,以及含有利尿剂的降压药,这类药物会降低肾脏排尿酸的能力,引起尿酸的升高,从而引起或诱发痛风。
部分血管扩张剂
β受体阻滞剂如美托洛尔,钙离子拮抗剂如硝苯地平、氨氯地平等,都可使肾血流减少,尿酸排泄减少。
阿司匹林
阿司匹林对尿酸代谢具有双重作用。大剂量阿司匹林(>3克/天)可明显抑制肾小管对尿酸的重吸收,使尿酸排泄增多;中等剂量阿司匹林(1~2克/天)则以抑制肾小管排泄尿酸为主;虽然小剂量阿司匹林(<0.5克/天)对尿酸作用的研究不多,但临床已经发现75~325毫克/天用量的阿司匹林能损害老年人肾功能和尿酸清除能力,而小剂量阿司匹林已被心脑血管患者广泛应用,特别是老年人。因此,应该警惕剂量改变对老年人所造成的损害。痛风急性发作时,应避免应用阿司匹林。
抗结核药
结核患者久用吡嗪酰胺和乙胺丁醇而不合用利福平时,多数患者血尿酸升高,也常常诱发痛风。吡嗪酰胺和乙胺丁醇都会抑制尿酸的排出而升高血尿酸,但利福平对吡嗪酰胺引起的关节痛有较好的疗效,可能与利福平抑制尿酸的吸收、加速尿酸的排泄有关。
免疫抑制剂
典型的药物是环孢素。一些风湿免疫科的患者,以及接受器官移植且服用环孢素的患者也是痛风的高危人群,尤其肾功能不全的换心或换肾的患者更不容易控制尿酸。这是因为环孢素会减少尿酸的排出。
部分抗生素
喹诺酮类(如氧氟沙星、加替沙星等)、青霉素等抗生素大多由肾脏排泄,但喹诺酮类、青霉素等抗生素的排出多就会影响尿酸的排出,使体内尿酸水平升高。
. 烟酸是降脂药中常用的药物,它虽然具有良好的降脂作用,但它兼有明显的升高血尿酸的副作用。
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