Gout in African Americans

Purpose

African Americans have a substantially higher prevalence of risk factors for gout than Caucasians. The aim of the present study was to compare the risk for incident gout among African Americans and Caucasians.

Methods

Incidence rates of physician-diagnosed gout among 11,559 Caucasian men and 931 African American men aged 35 to 57 years and at high cardiovascular risk, observed for 7 years as a part of the Multiple Risk Factor Intervention Trial, were analyzed. Cox regression models were used to account for potential confounding by age, body mass index, diuretic use, hypertension and diabetes status, aspirin and alcohol consumption, and kidney disease.

Results

At baseline, after accounting for risk factors, African Americans had a 14% lower prevalence of hyperuricemia than Caucasians. Incidence of gout increased with increasing prevalence of risk factors in both Caucasians and African Americans. Ethnic disparities in incidence rates were most apparent among those without other risk factors for gout. In separate Cox regression models, after accounting for risk factors, African American ethnicity was associated with a hazard ratio of 0.78 (95% confidence interval [CI], 0.66-0.93) for physician-diagnosed gout and 0.88 (95% CI, 0.85-0.90) for incident hyperuricemia. Significant interactions were observed; the association was the strongest (hazard ratio 0.47; 0.37-0.60). These associations were unaffected by addition of serum urate as a covariate or by using alternate case definitions for gout.

Conclusions

After accounting for the higher prevalence of risk factors, African American ethnicity is associated with a significantly lower risk for gout and hyperuricemia compared with Caucasian ethnicity.     

心理应激与高尿酸血症患者血尿酸关系研究

目的探讨生活事件心理应激相关因素与高尿酸血症患者血尿酸水平之间的关系。方法采用生活事件量表对60例高尿酸血症患者精神刺激进行定性和定量研究分析,并通过实验室检测分析比较不同压力下高尿酸血症患者的一般资料及生化指标的差异,并进一步进行相关性分析和多元回归分析。结果将生活事件量表总分小于等于20分的患者纳入低压力组,总分大于20分的纳入高压力组。正性、负性生活事件出现频率最高的事件分别为突出的个人成就、晋级和提升等,以及工作学习中压力大、生活规律重大变动、对现职工作不满意等。高压力组的患者最近1年的痛风发作频率以及总胆固醇、三酰甘油、血肌酐、血尿酸、皮质醇水平显著高于低压力组(P<0.05)。生活事件总刺激量与总胆固醇、三酰甘油、血肌酐和血尿酸呈正相关,其中正性生活事件刺激量与总胆固醇和三酰甘油呈正相关,负性生活事件刺激量和尿酸呈正相关。以血尿酸为因变量的多元线性回归分析中,最近1年痛风发作频率和压力分组最终进入回归模型,该回归模型具有统计学意义F(2,54)=27.765(P<0.01),调整R^2=0.522。结论在生活事件中的家庭生活和工作上受到的刺激较大的高尿酸血症患者,精神心理压力与机体总胆固醇、三酰甘油、血尿酸水平升高有关,其中三酰甘油和总胆固醇的升高与正性生活事件有关,而血尿酸的升高则是与负性生活事件有一定关系。高尿酸血症的患者,其较高的压力水平和频发的痛风与血尿酸升高有关。     

一种新型尿酸氧化酶四聚体提取纯化方法的建立

目的 建立一种简便、快速的尿酸氧化酶四聚体提取纯化的方法,以适应大规模生产需求。方法 首先通过基因工程的方法获得可以稳定发酵生产尿酸氧化酶的大肠埃希菌菌株,再通过一步萃取法从破碎菌体沉淀中获得尿酸氧化酶蛋白混合物,通过硫酸铵沉淀、离子交换和分子筛层析,最终获得纯化的活性尿酸氧化酶四聚体。结果 通过优化发酵及提取条件,每升发酵液可得到尿酸氧化酶四聚体蛋白约400 mg,其纯度>95%,比活>10 U/mg。结论 建立了一种新的尿酸氧化酶四聚体高效提取纯化的方法。     

Serum urate levels are unchanged with continuous positive airway pressure therapy for obstructive sleep apnea: a randomized controlled trial

ObjectiveHyperuricemia is associated with the presence and severity of obstructive sleep apnea (OSA). Previous work has shown that treatment of OSA with continuous positive airway pressure (CPAP) therapy reduces urinary uric acid excretion and serum urate, but there has been no previous randomized controlled investigation on the effects of CPAP therapy on serum urate; we aimed to assess this association.MethodsSerum urate was measured in samples from participants of a previously published randomized controlled trial. Samples were taken at baseline and after 3 months from men with known type 2 diabetes mellitus (T2DM) and newly diagnosed OSA, randomized to receive either therapeutic (n = 19) or placebo (n = 19) CPAP for 3 months.ResultsBoth groups were well matched at baseline, with no significant difference in age, body mass index (BMI), glycosylated hemoglobin (HbA1c), or oxygen desaturation index (ODI). There was no significant difference in therapeutic or placebo CPAP usage. There was no significant difference in urate levels between groups at baseline (362 μmol/L [standard deviation {SD}, 96] vs 413 μmol/L [SD, 91] [reference range, 110–428 μmol/L]) or at 3 months. Baseline urate did not correlate with ODI, BMI, or HbA1c. The mean change in urate at 3 months did not significantly differ between treatment groups (−7.6 μmol/L [SD, 35.9] vs −6.2 μmol/L [SD, 46.2]) (P = .9; [95% confidence interval, −28.7 to +25.9]).ConclusionOur randomized controlled trial has shown no significant reduction in serum urate following 3 months treatment with therapeutic or placebo CPAP.     

关节镜有限清理术等综合性措施治疗痛风性关节炎

目的探讨膝关节痛风性关节炎综合治疗中关节镜的作用和疗效。方法自2000年2月至2009年2月,对45例反复急性发作的膝关节痛风性关节炎患者进行关节镜诊治,利用刮匙除去紧密附着在负重面关节软骨上的尿酸盐结晶,对充血、增生的滑膜及其附着的尿酸盐结晶不予特殊处理;修整剥脱的关节软骨及受侵蚀的半月板;用大量冲洗液冲洗关节腔,最后关节腔内注射复方倍他米松注射液（得宝松）及罗哌卡因等复合药物。术后抗炎镇痛,合理饮食调节及降尿酸治疗。结果 45例患者术后病情均得到不同程度的缓解,28例患者随访期内未发生痛风急性发作。17例患者有2～3次的急性发作,与饮食控制不良和未坚持降尿酸治疗或患有高三酰甘油血症、肥胖等代谢性疾病有关。结论关节镜下手术治疗膝关节痛风性关节炎是一种起效快、微创、效果显著的方法,关节内对软骨、滑膜尽量少的干预及复合镇痛药物的应用,有效地缓解了疼痛。但关节镜微创治疗仅是综合治疗的一部分,尚需要合理饮食调节、降酸等配合治疗。     

多指标综合评分法优化痛风巴布剂的醇提工艺

目的 优选痛风巴布剂的最佳提取工艺。方法 以青藤碱、总生物碱的含量和干浸膏得率为评价指标,采用正交设计试验,考察乙醇浓度、乙醇用量、提取时间和提取次数对提取结果的影响,确定痛风巴布剂处方药材的最佳提取工艺。结果 痛风巴布剂的最佳提取工艺为65%乙醇,提取3次,每次6倍量溶剂,提取总时间为1.5 h,在该工艺条件下得到的青藤碱含量、总生物碱含量和干浸膏得率分别为2.79 mg·g^-1、1.22%和13.06%。结论 优选的醇提工艺稳定、可行。     

治疗痛风药物非布司他的临床应用与进展

为了更全面地了解治疗痛风新药非布司他（Febuxostat）的研发、临床应用信息,促进安全、合理用药,作者通过查阅大量的国内外文献,对非布司他基本情况、各国上市的时间、临床研究、安全性评价、注意事项等进行总结分析。非布司他作为新开发出来的治疗痛风的可选药物,疗效可靠,安全性较好,值得临床推广应用;作为新药,也应加强上市后的安全性监测。     

The effect of bariatric surgery on gout: a comparative study

BackgroundObesity is a risk factor for the development of gout. An increased incidence of early gouty attacks after bariatric surgery has been reported, but the data is sparse. The effect of weight loss surgery on the behavior of gout beyond the immediate postoperative phase remains unclear. The objective of this study was to evaluate the pre- and postoperative frequency and features of gouty attacks in bariatric surgery patients.MethodsCharts were reviewed to identify patients who had gout before bariatric surgery. Demographic and gout-related parameters were recorded. The comparison group consisted of obese individuals with gout who underwent nonbariatric upper abdominal procedures.ResultsNinety-nine morbidly obese patients who underwent bariatric surgery had gout. The comparison group consisted of 56 patients. The incidence of early gouty attack in the first month after surgery was significantly higher in the bariatric group than the nonbariatric group (17.5% versus 1.8%, P = .003). In the bariatric group, 23.8% of patients had at least one gouty attack during the 12-month period before surgery, which dropped to 8.0% during postoperative months 1–13 (P = .005). There was no significant difference in the number of gouty attacks in the comparison group before and after surgery (18.2% versus 11.1%, P = .33). There was a significant reduction in uric acid levels 13-months after bariatric surgery compared with baseline values (9.1±2.0 versus 5.6±2.5 mg/dL, P = .007).ConclusionThe frequency of early postoperative gout attacks after bariatric surgery is significantly higher than that of patients undergoing other procedures. However, the incidence decreases significantly after the first postoperative month up to 1 year.