别嘌呤醇治疗急性脑梗死伴高尿酸血症的临床效果

目的：探讨别嘌呤醇治疗急性脑梗死伴高尿酸血症的临床效果。方法选取2013年10月~2014年10月本院收治的80例急性脑梗死伴高尿酸血症患者作为研究对象,随机分为对照组和观察组,各40例。对照组给予抗凝、抗血小板聚集等对症治疗,观察组在对照组的基础上给予别嘌呤醇,比较两组治疗前后的血清尿酸水平、神经功能缺损评分以及临床效果。结果两组治疗后的血清尿酸水平与神经功能缺损评分显著低于治疗前,差异有统计学意义(P<0.05)。观察组治疗后的血清尿酸水平与神经功能缺损评分显著低于对照组治疗后,差异有统计学意义(P<0.05)。观察组的总有效率为92.5%,显著高于对照组的75.0%,差异有统计学意义(P<0.05)。结论别嘌呤醇能够明显降低急性脑梗死伴高尿酸血症患者的血清尿酸水平,改善患者的神经功能缺损症状,值得临床推广应用。     

Urate transport in health and disease

Circulation of urate levels is determined by the balance between urate production and excretion, homeostasis regulated by the function of urate transporters in key epithelial tissues and cell types. Our understanding of these physiological processes and identification of the genes encoding the urate transporters has advanced significantly, leading to a greater ability to predict risk for urate-associated diseases and identify new therapeutics that directly target urate transport. Here, we review the identified urate transporters and their organization and function in the renal tubule, the intestinal enterocytes, and other important cell types to provide a fuller understanding of the complicated process of urate homeostasis and its role in human diseases. Furthermore, we review the genetic tools that provide an unbiased catalyst for transporter identification as well as discuss the role of transporters in determining the observed significant gender differences in urate-associated disease risk.     

Relationship between uric acid and lipid accumulation product index by gender in Korean adults: The 2016 Korean National Health and Nutrition Examination Survey

AimsThe present study assesses the relationship between uric acid (UA) and lipid accumulation product index (LAP) by gender among Korean adults.MethodsData from 5670 subjects (2463 men and 3207 women) in the Korean National Health and Nutrition Examination Survey (KNHANES VII-1) 2016 were analyzed. LAP was divided into four quartiles (Q1–Q4).ResultsThere were several key findings. Compared with Q1, in the overall population, the odds ratios (ORs) of hyperuricemia (UA ≥ 7.0 mg/dL in men or UA ≥ 6.0 mg/dL in women) were significantly higher in Q2 [1.847 (95% confidence interval [CI], 1.325–2.575)], Q3 [3.050 (95% CI, 2.216–4.198)], and Q4 of LAP [6.367 (95% CI, 4.658–8.704)]. In men, the ORs of hyperuricemia were significantly higher in Q2 [1.658 (95% CI, 1.162–2.367)], Q3 [2.341 (95% CI, 1.656–3.308)], and Q4 [4.633 (95% CI, 3.290–6.525)] than Q1. In women, the ORs of hyperuricemia were significantly higher in Q2 [2.254 (95% CI, 1.085–4.680)], Q3 [5.402 (95% CI, 2.735–10.668)], and Q4 [11.025 (95% CI, 5.620–21.628)] than Q1. In addition, UA levels were positively associated with LAP level in men (r = 0.218; p < 0.001), women (r = 0.261; p < 0.001), and the overall population (r = 0.260; p < 0.001).ConclusionsHyperuricemia was positively associated with LAP in Korean men and women.     

高尿酸血症与冠心病的相关性

为探讨高尿酸血症与冠心病之间的关系 ,对 2 0 0 9例拟诊冠心病行冠状动脉造影的患者测定禁食 12h后静脉血清尿酸值及其它生物化学指标。结果发现 ,冠心病组血清尿酸显著高于正常冠状动脉组 (36 9± 97mmol/L比 35 6± 94mmol/L ,P <0 .0 1)。单因素分析显示 ,高尿酸血症与冠心病显著相关 (χ2 MH=4 .36 4 ,P =0 .0 37,OR值为1.2 4 )。急性心肌梗死患者尿酸增高病例数较正常冠状动脉组明显增多。多因素回归分析显示血清尿酸与冠心病(χ2 wald=4 .76 ,P =0 .0 2 92 ,OR值为 0 .999)和急性心肌梗死 (χ2wald=2 3.4 8,P =0 .0 0 0 1,OR值为 1.0 0 4 )呈显著正相关。糖尿病或吸烟合并高尿酸血症时 ,OR值均明显升高。因此 ,高尿酸血症与冠心病发病显著相关 ,尤其当合并糖尿病或吸烟时该关系更为明显。     

体质指数对高尿酸血症发病的影响

摘要：目的　探讨３５岁以上人群体质指数（ＢＭＩ）对高尿酸血症（ｈｙｐｅｒｕｒｉｃｅｍｉａ,ＨＵＡ）发病的影响。方
法　以２００６年健康体检尿酸正常的８１１名北京某企业３５岁以上在职及离退休职工为基线人群,调查内容包
括年龄、性别、血压、血糖、血脂、尿酸、吸烟史、饮酒史等,并进行４年随访,每年随访体质指数及尿酸,
至２０１０年有效人群６０９人,平均年龄（５６．５２±１２．８９）岁。结果　ＢＭＩ基线为低体质量（１７例）、正常（２９２
例）、超重（２４２例）、肥胖（５８例）人群４年内高尿酸血症累积发病人数分别为１例、３２例、４８例、１６例,
发病率分别为５．８８％、１０．９６％、１９．８３％、２７．５９％,其发病率随着ＢＭＩ的增加呈增高趋势（χ
２ ＝１５．１８１,
犘＝０．００２）;超重、肥胖人群的发病率分别是正常体重人群的１．８０ （１．１８～２．７４）和２．５１ （１．４２～４．４５）倍;
低体质量人群发病率与正常人群发病率差异无统计学意义。５年均处于超重（含肥胖）的１９５人与均未超重
的２７４人的累积发病率分别为２４．６２％、９．４９％,前者是后者的２．５９ （１．６８～４．０１） 倍,其中男性为１．９７
（１．０８～３．５８）倍,女性为３．４０ （１．７１～６．７３）倍。经偏回归分析,扣除年龄、性别、吸烟、饮酒、血压、血
糖、血脂的影响,ＨＵＡ 的发病次数与超重次数以及尿酸均值与ＢＭＩ均值均呈正相关（犘＜０．０１）。结论　超
重或肥胖增加了高尿酸血症的发病风险,控制体质量是降低高尿酸血症流行的有效途径。
关键词：体质指数;高尿酸血症;发病率;随访研究
中图分类号：Ｒ５８９．７　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０６ ０６０４ ０４     

Hyperuricemia and incident atrial fibrillation in a normotensive elderly population in Taiwan

Background and aimAtrial fibrillation (AF) is an important cardiovascular disease in the elderly. The association between hyperuricemia and AF is unclear. Therefore, we aimed to investigate the prospective relationship between uric acid and development of AF in a nationally representative cohort of elderly people.Methods and resultsA total of 1485 elderly people (age ≥ 65 yrs) from the Elderly Nutrition and Health Survey in Taiwan (1999–2000) were without AF on “electrocardiography” at baseline. Incident AF events (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM: 427.31) were identified using data from the National Health Insurance Dataset. Hyperuricemia was defined as levels of uric acid >7.0 mg/dL in men and 6.0 mg/dL in women. A Cox proportional hazards model was used to evaluate the association between hyperuricemia and incident AF.The follow-up period was from 1999 to 2000 to 2008. During the follow-up period (median: 9.16 yrs), 90 AF events occurred (44 in men and 46 in women). Older age, elevated systolic blood pressure, being an ex-smoker, and high uric acid were positively associated with incident AF. Hyperuricemia was positively associated with incident AF in normotensive (age-adjusted hazard ratio (HR): 2.65 and 95% confidence intervals: 1.05–6.69), but not in (1.20:0.74–1.94) hypertensive individuals (systolic blood pressure ≥130 or diastolic blood pressure ≥85 or using hypertensive medicine). A significant association between hyperuricemia and AF (3.78; 1.24–11.59) remained after adjusting for other potential confounders among normotensive older persons.ConclusionHyperuricemia is associated with the development of AF in elderly people with normal blood pressure.     

Hyperuricemia and risk of stroke: A systematic review and meta-analysis of prospective studies

Introduction

Hyperuricemia may be associated with an increased risk of stroke, but to date results from prospective studies have been inconsistent. This study aimed to evaluate the association between hyperuricemia and risk of stroke incidence and mortality by performing a meta-analysis.

Materials and methods

Studies were identified by searching multiple electronic databases through July 13, 2013, and by reviewing reference lists of obtained articles. Prospective studies reported a multivariate-adjusted estimate, represented as relative risk (RRs) with 95% confidence intervals (CIs) for the association between hyperuricemia and risk of stroke incidence and mortality were eligible. A random-effects model was used to compute the pooled risk estimate.

Results

A total of fourteen articles including results from 15 prospective studies with 22,571 cases of stroke and 1,042,358 participants were included in the meta-analysis. Overall, presence of hyperuricemia was associated with a significantly greater risk of both stroke incidence (RR, 1.22; 95% CI, 1.02–1.46) and mortality (RR, 1.33; 95% CI, 1.24–1.43). In addition, the pooled estimate of multivariate RRs of stroke incidence and mortality were 1.08 (95% CI: 0.85–1.38); 1.26 (95% CI: 1.14–1.40) among men and 1.25 (95% CI: 1.04–1.46); 1.41 (95% CI: 1.31–1.52) among women respectively.

Conclusions

Results from this meta-analysis indicate that hyperuricemia may modestly increase the risks of both stroke incidence and mortality. Future studies should explore whether hyperuricemia is a modifiable risk factor for stroke.     

健康体检人群血清尿酸水平及高尿酸血症的分布特点分析

目的研究健康体检人群血清尿酸(SUA)水平及高尿酸血症(HUA)的分布特点。方法选取2018年2月至2019年2月我院健康体检人群20874例并采集晨起空腹外周静脉血5 mL,凝固、分离后取上清,采用酶比色法检测SUA水平同时进行HUA诊断,分析不同年龄和性别人群SUA水平和HUA检出率变化,比较不同SUA水平人群高血压、糖尿病及心血管疾病等发生率。结果60岁以上男性SUA水平低于18~60岁组;50岁以上女性SUA水平高于18~50岁组,60岁以上女性SUA水平高于51~60岁组;且各年龄段男性SUA水平均高于女性,差异有统计学意义(P<0.05);20874例受检者中共检出HUA患者4584例,占比21.96%,男性和女性HUA检出率分别为29.39%和13.80%,其中男性60岁以上年龄段HUA检出率明显低于18~60岁组,女性HUA检出率随年龄增加而升高,51~60岁年龄段HUA检出率高于18~50岁组,60岁以上年龄段HUA检出率高于18~60岁组,且18~60岁年龄段男性HUA检出率高于女性,60岁以上年龄段男性HUA检出率低于女性,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,男性、HUA家族史、BMI增加、GFR降低、饮酒史、糖尿病以及高脂血症均为HUA发病的独立危险因素(P<0.05)。结论60岁以上男性SUA水平明显降低,50岁以上女性SUA水平明显升高,针对不同年龄段男性和女性分别制定相应参考值范围有利于提升HUA诊断和治疗水平,对改善患者身心健康具有重要意义。     

Renal disease in Cockayne syndrome

BackgroundCockayne Syndrome (CS) is a rare autosomal recessive multi-systemic disorder, characterized; by developmental delay, microcephaly, severe growth failure and sensorial impairment. Renal complications have been reported but remain underinvestigated. The objective of this study was to perform a review of renal disease in a cohort of CS patients.MethodsWe retrospectively collected relevant clinical, biochemical and genetic data from a cohort of 136 genetically confirmed CS patients. Blood pressure (BP), proteinuria, albuminemia, uric acid, creatinine clearance, renal ultrasounds and renal biopsy result were analysed.ResultsThirty-two patients had a renal investigation. We found that 69% of investigated patients had a renal disorder and/or an elevated BP. Fifteen out of 21 patients (71% of investigated patients) had an increased BP, 10 out of 16 patients (62% of investigated patients) presented with proteinuria and 4 of them had a nephrotic syndrome. Thirteen patients out of 29 (45%) had a decreased Glomerular Filtration Rate (GFR), 18 out of 25 patients (72%) had a hyperuricemia. No correlation with the genetic background or clinical types of CS was found, except for the renal clearance.ConclusionsRenal disease, increased blood pressure and hyperuricemia were highly prevalent in our study. We believe that CS patients should benefit from a nephrological follow-up and that anti-uric acid drug and Angiotensin-converting enzyme (ACE) inhibitor should be discussed in these patients.     

脉搏波传导速度评估高尿酸血症对颈动脉硬化的影响

高尿酸血症是体内的嘌呤代谢异常、尿酸盐沉积而引起组织损害的一组疾病,其临床症状包括痛风性关节炎、关节畸形和痛风性肾病等[1]。近年来,随着人们生活水平的提高和饮食结构的改变,高尿酸血症的患病率逐年增加。研究[2]表明高尿酸血症可能与周围动脉硬化性疾病的发生及发展有一定的关系,血清尿酸水平升高是多种心血管疾病的独立危险因素和预后因子。脉搏波传导速度(pulse wave velocity,PWV)是目前评估动脉血管弹性的较优指标[3],本组应用PWV评估高尿酸血症患者颈动脉血管弹性,旨在探讨其在提示颈动脉硬化程度中的临床意义。