单味中药降尿酸作用机制概述※

降尿酸是治疗痛风和高尿酸血症的基本方法，目前降尿酸作用途径主要是通过抑制黄嘌呤氧化酶、腺苷脱氨酶等合成酶的活性，或（且）影响肾脏尿酸转运蛋白（OAT1、OAT3、URAT1、GLUT9）等的表达，进而降低尿酸的水平。由于中药治疗高尿酸血症及痛风的作用机制尚不明确，因此本文通过检索中国知网、维普、万方、pubMed、Embase等数据库，对相关文献进行筛选，总结了具有明确降尿酸作用机制的单味中药，并进行功效归类，有助于对其作用机制进一步研究，为防治痛风和高尿酸血症提供更可靠、更安全的中医治疗依据。     

酒钢职工高尿酸血症现况调查及影响因素分析

目的探讨对患有高尿酸血症的酒钢职工患者进行研究调查,明确此类疾病的影响因素。方法以2017年12月-2018年12月在本院进行健康体检的17 611名检查者为研究对象,其中包括男性职工和女性职工分别有16 992例和619例,截取患者健康体检资料,分析职工患有高尿酸血症的患病概率,并采用多因素logistics回归分析,明确患病率的影响因素。结果高尿酸血症患者患病率为30.5%,其中男性患病率为31.3%,女性患病率为9.9%;高尿酸血症的人群中,超重及肥胖、高甘油三脂、高低密度脂蛋白、高血压患病率均明显高于正常尿酸组;组间数值差异较大(P <0.05)。结论酒钢职工高尿酸血症检出率较高,高尿酸血症与性别、体质指数、血脂、血压密切相关,应给予足够重视,及早进行综合干预。     

社区老年高尿酸血症患者的群组管理

目的评价群组管理用于社区老年高尿酸血症患者管理的效果。方法将87例社区老年高尿酸血症患者按所属卫生服务站分为观察组47例和对照组40例。对照组实施社区常规管理;观察组采用群组管理,每2周1次,干预4个月后评价效果。结果干预后,观察组高尿酸血症相关知识、信念、健康相关行为总分和血尿酸达标率显著高于对照组,血尿酸显著低于对照组(均P0.01)。结论群组管理有助于改善社区老年高尿酸血症患者知识、信念、健康相关行为及血尿酸控制情况。     

Uric acid and incident chronic kidney disease in dyslipidemic individuals

Background: Elevated uric acid (UA) is a recognized risk factor for chronic kidney disease (CKD). This study aimed to investigate whether this association exists in dyslipidemic patients receiving multifactorial treatment.

Methods: An observational study conducted in Greece including 1,269 dyslipidemic individuals followed-up in a lipid clinic for ≥3 years. Estimated glomerular filtration rate (eGFR) was calculated by CKD-EPI equation and CKD was defined as ≤60?mL/min/1.73 m². The correlation was assessed between UA levels and the CKD risk after adjusting for potential confounding factors, after defining the following UA quartiles: Q1: ?6?mg/dL.

Results: After excluding patients with baseline eGFR <60?mL/min/1.73 m², gout and those taking UA-lowering drugs, 1,095 individuals were eligible; of those, 91% and 69% were treated with statins and anti-hypertensive drugs, respectively. During their follow-up (6 years; IQR?=?4–10), 11.9% of the subjects developed CKD, whereas the median annual eGFR decline was 0.69?mL/min/1.73 m² (IQR?=?0.45–2.33). Multivariate analysis showed that baseline UA levels (HR?=?1.26; 95% CI?=?1.09–1.45, p?=?.001), female gender (HR?=?1.74; 95% CI?=?1.14–2.65, p?=?.01), age (HR?=?1.10; 95% CI?=?1.07–1.12, p?p?=?.03), cardiovascular disease (HR?=?1.62; 95% CI?=?1.02–2.58, p?=?.04), decreased baseline renal function (eGFR <90?mL/min/1.73 m²) (HR?=?2.38; 95% CI?=?1.14–4.81, p?=?.02), and low-density lipoprotein cholesterol reduction (HR?=?0.995; 95% CI?=?0.991–0.998, p?=?.01) were associated with incident CKD. Additionally, patients with UA ≥6?mg/dL exhibited a higher risk of incident CKD compared with those in the lowest UA quartile (HR?=?2.01; 95% CI?=?1.11–3.65, p?=?.02).

Conclusion: Higher UA levels are correlated with a higher risk of incident CKD in dyslipidemic individuals taking multifactorial treatment.     

苯溴马隆对高尿酸血症模型大鼠脂质代谢的影响

目的 基于脂质组学方法研究苯溴马隆治疗高尿酸血症（hyperuricemia,HUA）大鼠的作用机制,并揭示尿酸水平增高与脂质代谢异常的内在相关性。方法 利用超高效液相色谱-四极杆飞行时间质谱（UPLC-Q-TOF/MS）技术,结合主成分分析（PCA）和偏最小二乘法判别分析（OPLS-DA）研究正常组、模型组和苯溴马隆组的大鼠血清中内源性脂质代谢物的变化,寻找潜在生物标记物,分析相关代谢通路,绘制代谢网络机制图。结果 脂质组学分析发现,苯溴马隆可使HUA大鼠体内水平异常的20个差异代谢物回调到正常水平;相关代谢通路分析发现,苯溴马隆影响果糖诱导HUA大鼠血清中的脂质水平,主要与甘油磷脂代谢通路相关。结论 苯溴马隆对HUA的治疗可能与改善体内甘油磷脂代谢通路异常密切相关。     

Design,synthesis, and molecular docking studies of N‐(9,10‐anthraquinone‐2‐carbonyl)amino acid derivatives as xanthine oxidase inhibitors

A series of N‐(9,10‐anthraquinone‐2‐carbonyl)amino acid derivatives ( 1a–j ) was designed and synthesized as novel xanthine oxidase inhibitors. Among them, the L/D‐phenylalanine derivatives ( 1d and 1i ) and the L/D‐tryptophan derivatives ( 1e and 1j ) were effective with micromolar level potency. In particular, the L‐phenylalanine derivative 1d (IC₅₀ = 3.0 μm ) and the D‐phenylalanine derivative 1i (IC₅₀ = 2.9 μm ) presented the highest potency and were both more potent than the positive control allopurinol (IC₅₀ = 8.1 μm ). Preliminary SAR analysis pointed that an aromatic amino acid fragment, for example, phenylalanine or tryptophan, was essential for the inhibition; the D‐amino acid derivative presented equal or greater potency compared to its L‐enantiomer; and the 9,10‐anthraquinone moiety was welcome for the inhibition. Molecular simulations provided rational binding models for compounds 1d and 1i in the xanthine oxidase active pocket. As a result, compounds 1d and 1i could be promising lead compounds for further investigation.     

菊苣提取物对高尿酸血症大鼠肾脏果糖转运体9表达的影响

该研究给予雄性SD大鼠10%果糖饮水建立高尿酸血症模型,将其分为正常组、模型组、苯溴马隆组(20 mg·kg~(-1)·d~(-1))、菊苣提取物高、中、低剂量组(5,7.5,10 g·kg~(-1)·d~(-1)),连续42 d。分别测定血尿酸、血肌酐、尿素氮、尿尿酸,计算肾脏尿酸清除率;免疫组化法、逆转录实时荧光定量PCR(RT-q PCR)法分别检测果糖转运体9(glucose transporter family member 9,Glut9)在大鼠肾脏的蛋白及基因的表达水平。探讨中药菊苣提取物降尿酸作用及对肾脏Glut9表达的影响。结果显示菊苣提取物能降低高尿酸血症大鼠血尿酸水平,增加肾脏尿酸清除率,降低肾脏Glut9的蛋白表达,抑制肾脏尿酸重吸收,从而促进肾脏尿酸排泄。     

高尿酸血症及痛风患者饮食控制知信行量表的编制及验证

目的编制高尿酸血症及痛风患者饮食控制知信行量表(知信行量表)并进行信效度验证。方法以知信行理论为基本框架,通过查阅文献、小组访谈、专家函询、预调查形成初始量表,经预测试、大样本测试形成正式量表,并进行信效度检验。结果知信行量表包括知识、信念、行为3个分量表共计9个维度37个条目。总量表Cronbach′sα系数为0.889,3个分量表Cronbach′sα系数为0.754~0.864;总量表重测信度为0.845,3个分量表重测信度为0.638~0.802。探索性因子分析确定总量表9个维度,3个分量表维度分别为3、4、2个,累积方差贡献率分别为63.350%,60.855%,66.826%和61.941%。聚敛效度r值为0.777~0.867,分殊效度r值为0.365~0.554(均P<0.01);量表内容效度为0.918;医务工作者与非医务工作者总量表及分量表得分差异有统计学意义(P<0.05,P<0.01)。结论知信行量表具有较好的信度和效度,可作为测评高尿酸血症及痛风患者饮食控制知信行的工具。     

清血汤治疗肾性高尿酸血症疗效观察

[目的]观察中药清血汤治疗肾性高尿酸血症的疗效。[方法]将60例患者随机分两组,每组各30例。对照组采用常规治疗加别嘌醇,治疗组用常规治疗加清血汤,8周后统计疗效。[结果]治疗组可以降低血肌酐、尿素氮、血尿酸和升高肾小球滤过率,与治疗前相比差异有统计学意义(P0.01);治疗组降低血肌酐、尿素氮和升高肾小球滤过率与对照组相比差异有统计学意义(P0.01);对照组降低血尿酸与治疗组相比差异有统计学意义(P0.01)。[结论]清血汤可以改善慢性肾脏病3期继发高尿酸血症(肾性高尿酸血症)患者的临床症状、肾功能,并降低升高的血尿酸。