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另一半得了痛风，能不能嫁？

2021-09-26 Dr.Wu彤/Shirley MedSci原创

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痛风作为一种代谢性疾病，近年来发病率逐年提高，并且痛风的人也越来越年轻，原本的“老年病”在“小伙子”中也变得很常见。

痛风作为一种代谢性疾病，近年来发病率逐年提高，并且痛风的人也越来越年轻，原本的“老年病”在“小伙子”中也变得很常见。
 
男女患有痛风的比例大概是15:1，属于严重的“重男轻女”。
年轻的痛风患者往往面临着结婚、生育的问题。

同样，如果另外一半得了痛风，大家也会有所担忧。例如：

痛风会遗传吗？

痛风会影响生育吗？

治疗痛风的药物会影响生育吗？

治疗痛风花费如何？

爱人得了痛风我应该做一些什么？

01# 痛风会遗传吗？

原发性痛风具有遗传倾向性，人们很早就发现痛风具有家族聚集现象。

但是，痛风的遗传变异性很大，痛风的发生与多种因素有关，受很多外界因素的影响，遗传只是其中的因素之一。

原发性痛风，遗传比例通常只有1%-2%左右。

继发性痛风是不会遗传的。

患痛风更多的原因是外源性尿酸摄入过多超出人体代谢能力所致。

有哪些遗传机制呢？

（1）遗传缺陷导致嘌呤代谢紊乱，合成嘌呤的酶功能增强或抑制嘌呤分解的酶功能减低，内源性尿酸生成过多导致痛风。

（2）肾脏尿酸转运通路的特异性蛋白结构异常，肾脏排泄尿酸的能力下降，尿酸蓄积体内导致痛风。

（3）一些先天性遗传性疾病通过不同的途径引起继发性痛风，比如：Ⅰ型糖原累积综合征。

总结：遗传倾向的强弱，还与其他因素，包括环境因素、生活习惯、社会地位等。

痛风病人完全有生育的权利，也不影响正常的夫妻生活。

如果你一定下定决心陪你的另一半一程，那痛风不是阻碍你们在一起的因素。

 

02痛风会影响生育吗？

对于男性：
痛风对男性的生育和性功能几乎没有不良影响。抗痛风的药物主要经由肾脏代谢排出后随着尿液排出，一般不会对男性的生殖功能造成影响。
对于女性：
流行病学研究证实痛风在女性中并不常见，患病率为 0.04-5%。且大多数女性是在更年期之后。所以从这个角度育龄期的女性得痛风的概率还是很低的。

育龄期女性得痛风会影响妊娠吗？

目前由于育龄期得痛风属于罕见病，所以样本量太小，还没有足够多的临床数据来说明痛风对妊娠有怎样的影响。但是根据现有的数据来看，大多数女性痛风患者在医生正确的治疗下，都能够孕育出健康的婴儿。
但是对于女性痛风患者在怀孕期间付出的可能要比正常人多很多。在怀孕期间他们患先兆子痫、肾功能衰竭、严重脱水、妊娠期急性脂肪肝等并发症的风险比常人增加许多。
所以一定要珍惜那个肯为你孕育下一代的女性痛风患者，她们付出的远比你想的多！

03

治疗痛风的药物会影响生育吗？

痛风急性发作期的治疗主要以抗炎止痛为主，包括非甾体抗炎药、秋水仙碱和糖皮质激素三类药物。

抗炎止痛药对生育有何影响呢？

*在妊娠早期，NSAIDs在FDA药物分类中属于B类，考虑妊娠前3个月使用NSAIDs有增加胎儿畸形/流产的风险，一般建议在早期妊娠时应谨慎使用。

*在妊娠中期，如必须使用NSAIDs时，可以在医生指导下谨慎使用，且应选非选择性、半衰期短的药物（如洛索洛芬钠、布洛芬等）。最低有效剂量间断应用NSAIDs可降低对胎儿的风险。缓解后及时停药。

秋水仙碱对生育有何影响？

秋水仙碱是治疗痛风急性发作的特效药，在美国FDA妊娠期用药分类中属于D类，可抑制细胞有丝分裂，女性妊娠期不建议使用。但也有研究显示，秋水仙碱的应用对于男女生育能力无明确的负面影响，所以男性痛风患者备孕期间可考虑使用最小剂量的治疗方案，即每天1-2次，每次一片的小剂量治疗方案。

糖皮质激素对生育有何影响？

*糖皮质激素在美国FDA妊娠期用药分类中属于B类（短效：泼尼松）和C类（长效：地塞米松），目前尚缺乏糖皮质激素对男性生育影响的直接相关证据。曾有大剂量糖皮质激素对男性生育影响的研究提示，糖皮质激素与男性生育并没有直接影响。所以可以推荐男性痛风患者在急性发作期按最小有效剂量服用，缓解后及时停药。

总的来说，如果有备孕计划，不管是男性还是女性都能够在主治医师那里得到一份兼顾疗效和生育需求的治疗方案。

04治疗痛风花费如何？

疾病的治疗花费从来都不是一个可以回避的问题。那痛风的治疗究竟花费几何呢？

治疗痛风的药物并不昂贵。上文中提到的秋水仙碱、非布司他、苯溴马隆、和激素类药物并不会对大多数家庭造成很大的负担。

别嘌醇（0.1g/片），单价0.7~1元一片，每日2~3片

非布司他（40mg/片），单价1.5~2元一片，最大剂量每日80mg

秋水仙碱（1mg/片），单价0.7~0.8元/片，非急性期每日1片。

（以上价格和用量仅供参考，会因地域、病人个体化用药等变化）

 

根据一项包含了127例患者的统计数据表明，痛风患者包含药物，检查等其他诊疗费用，平均一年总花费约为8000元，平均一个月为667元。

 

05

爱人得了痛风我应该做一些什么？

既然决定和你爱的那个ta携手走上一段路，那可以做一些什么来帮助你的那个ta呢？

心理护理

这可能与痛风病人病程较长、疾病反复发作以及长期用药、疾病治疗的经济压力和严格的饮食控制有都影响痛风病人的心理健康状况。
患者家属应尽可能多的和患者按触，注意患者情绪变化，安慰、劝解患者，鼓励患者树立战胜疾病的信心。
所以当你的另一半是痛风患者的时候，你要做的是监督他控制饮食、多运动、多喝水，靠健康的生活方式来降酸。只要坚持，尿酸降下来，痛风也就很少会发作。

合理饮食

痛风家属应当督促和监督患者合理饮食。
应当避免高嘌呤食物，尽量选择低嘌呤食物。
第一等是超高嘌呤食物，痛风和高尿酸血症的患者应当完全避免这些食物。如各种动物内脏；部分水产品；浓肉汤、浓鱼汤、海鲜火锅汤和羊肉火锅汤等。
第二等是中高嘌呤食物，患者应当严格限量，在急性发作期不能食用。如各种畜肉；禽肉；部分鱼类；甲壳类，还有干豆类。 
第三类是中低嘌呤含量的食物，如深绿色嫩茎叶蔬菜；花类蔬菜；嫩豆类蔬菜；未干制的菌类；部分水产类。 
第四类是低嘌呤含量食物，几乎无需顾忌其嘌呤含量。如奶类；各种蛋类；浅色叶菜；根茎类蔬菜；茄果类蔬菜；瓜类蔬菜；各种水果；各种粮食。

健康生活

对于饮酒吸烟的患者，家属应当监督病鼓励痛风患者戒烟戒酒。同时可以和患者一起规律运动，早睡早期。这样一方面可以帮助患者缓解病情，另外一方面健康的生活方式也可以带来心情的愉悦。
一起养成良好的生活习惯，一起健康的慢慢变老，应是人生中第一幸运和浪漫的事情了吧。

痛风不是不治之症，只要患者坚持正规的治疗，另外多注意生活饮食细节，即可有效的预防和阻止痛风的发生和发展，使患者维持正常的生活和工作，提高患者的生活质量。作为痛风患者的另一半，如果已经决定共度一生，就请牢牢的牵起ta的手，一起面对这正活动的小挫折吧！
 

参考文献

1.遗传背景对痛风和/或高尿酸血症影响的初探，张冰清，北京协和医学院，2013

2.Tanya J. Major.et al. An update on the genetics of hyperuricaemia and gout. Nature Reviews Rheumatology. 14, 341-353 (2018).

3.Meng-tse Gabriel Lee.et al.Integrative Genome-Wide Association Studies of eQTL and GWAS Data for Gout Disease Susceptibility. Scientific Reports. 9, 4981 (2019).

4.尿酸转运蛋白相关基因多态性与原发性痛风遗传易感性关系的荟萃分析，黄海燕等，浙江医学，2017

 

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    2021-09-27 查查佳佳

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    2021-09-27 黄小丫

    学习

    0

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    2021-09-26 心不在遥远

    学习一下

    0

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    2021-09-26 心不在遥远

    学习学习

    0

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    2021-09-26 ms1000001139182687

    学习啦

    0

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    2021-09-26 光明骑士

    学习啦

    0

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    2021-09-26 ms6000000800992147

    良好的生活习惯很重要

    0

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    2021-09-26 谭桂峰

    规范诊治

    0

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    2021-09-26 鸿毳沉舟

    学习

    0