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1. https://www.szyy.com.cn/sys-nd/1340.html
2. ¸ßάÇÙ, µÈ. Í´·ç´ï±êÖÎÁÆÈËȺÓÃÒ©ÕæÕæÏàÐÎÆÊÎö£º¶àÖÐÐÄÕæÊµÌìÏÂÑо¿Ð§¹û[J]. Öлª·çʪ²¡Ñ§ÔÓÖ¾,2023,27(06):361-367.
3. Fenando A, et al. Gout[M]. Updated 2024 Feb 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
4. ÖлªÒ½Ñ§»áÄÚÉøÍ¸Ñ§·Ö»á. Öйú¸ßÄòËáѪ֢ÓëÍ´·çÕïÁÆÖ¸ÄÏ(2019)[J]. ÖлªÄÚÉøÍ¸´úлÔÓÖ¾, 2020, 36(01):1-13.
5. Ðì¶«, µÈ. Í´·çÕïÁƹ淶[J]. ÖлªÄÚ¿ÆÔÓÖ¾,2023,62(9):1068-1076.
6. Cipolletta E, et al. Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout[J]. JAMA. 2022 Aug 2;328(5):440-450.
7. Cipolletta E, et al. Risk of Venous Thromboembolism With Gout Flares[J]. Arthritis Rheumatol. 2023 Sep;75(9):1638-1647.
8. Yu KH, et al. Risk of end-stage renal disease associated with gout: a nationwide population study[J]. Arthritis Res Ther. 2012 Apr 18;14(2): R83.
9. lm, Pek KeiChen, et al. The Lancet Regional Health -Western Pacific, article in press.
10. Jiang N, et al. NLRP3 Inflammasome: A New Target for Prevention and Control of Osteoporosis?[J]. Front Endocrinol (Lausanne). 2021 Sep 27;12:752546.
11. Luo Z, et al. Role of microRNA alternation in the pathogenesis of gouty arthritis[J]. Front Endocrinol (Lausanne). 2022;13:967769.
12. Ourada T, et al. Intercritical Gout Represents a Systemic Inflammatory State [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). Accessed November 6, 2024.
13. Becker MA, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout[J]. N Engl J Med. 2005 Dec 8;353(23):2450-61.
14. Wortmann RL, et al. Effect of prophylaxis on gout flares after the initiation of urate-lowering therapy: analysis of data from three phase III trials[J]. Clin Ther. 2010 Dec;32(14):2386-97.
15. ÖйúҽʦлἱÕïҽʦ·Ö»á, ÖлªÒ½Ñ§»á¼±Õïҽѧ·Ö»á, ÖйúҽʦлáÇÀ¾ÈËÕÐѺÍÔÖÄÑҽѧרҵίԱ»á, µÈ. ÇïË®ÏɼîÖж¾ÁÙ´²ÕïÖÎר¼Ò¹²Ê¶ [J] . Öлª¼±ÕïҽѧÔÓÖ¾, 2023, 32(2) : 162-168.
16. Xue Y, et al. Efficacy and Safety of Genakumab versus Compound Betamethasone in Gout: The GUARD-1 Study [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9).
17. Ridker PM, et al. CANTOS Trial Group . Antiinflammatory therapy with canakinumab for atherosclerotic disease[J]. N Engl J Med. 2017;377(12):1119-1131.
18. Everett BM, et al. Anti-inflammatory therapy with canakinumab for the prevention of hospitalization for heart failure[J]. Circulation. 2019;139(10):1289-1299.
19. Zhao R, et al. A critical role for interleukin-1¦Â in the progression of autoimmune diseases[J]. Int Immunopharmacol. 2013 Nov;17(3):658-69.
20. Syed Ali Wijdan, et al. The role of interleukin-1 beta in inflammation and the potential of immune-targeted therapies[J].doi.org/10.1016/j.prerep.2025.100027.https://www.sciencedirect.com/science/article/pii/S2950200425000011
21. Dalbeth N, et al. Gout[J]. Nat Rev Dis Primers. 2019 Sep 26;5(1):69.