痛风和高尿酸血症的危险因素

痛风和高尿酸血症的患病率正逐年升高，且随年龄而渐增，一般男性发病高于女性。不同种族高尿酸血症／痛风的患病率也不同，可能与饮食习惯及生活方式有关。大多数高尿酸血症／痛风患者有遗传倾向，主要是由于嘌呤代谢催化酶缺陷使尿酸生成过多所致。此外，代谢综合征症侯群，如糖尿病、冠心病、高血压、肥胖等也与高尿酸血症／痛风有关。     

营养和代谢疾病

·522·中国医学文摘·内科学1996年第17卷第6期 964926原发性痛风216例与原发性高尿酸血症108例临床分析/翁建平…刀新医学一1996,27(4)一184一185 痛风组泌尿系结石发生率为21.3%,其中34%发生肾功能不全,而无泌尿系结石者发生肾功能不全仅为7.1%。高尿酸血症组泌尿系X线不透光结石9例;伴发高血压33例,其中10例出现肾功能不全。痛风组94例有痛风石,其平均病程、血尿酸水平均长于或高于无痛风石组。高血压病、高脂血症、冠心病等是痛风常见伴发症,而高尿酸血症组中这些伴发症也十分常见。高尿酸血症者虽无痛风之临床表现也应积极控制血尿酸…     

膳食营养与高尿酸血症和痛风的关系

饮食治疗在高尿酸血症及痛风的作用已被研究证实,随着研究的不断深入,传统的低蛋白、低嘌呤治疗观念正逐步被更新.高尿酸血症及痛风患者常合并高血压、心血管疾病等,因此饮食治疗不仅应控制食物种类,还要进行饮食结构的调整,以便在高尿酸血症及痛风得到缓解的同时降低伴发疾病的风险.     

痛风/高尿酸血症患者生活习惯的危险因素

目的探讨痛风/高尿酸血症患者生活习惯中的危险因素。方法应用自行设计的调查表,分别对病例组和对照组进行问卷调查,调查内容包括一般的基线资料和可疑的生活习惯危险因素。结果秩相关分析结果显示,饮酒、周围人吸烟、疲劳、精神紧张、喝咖啡、作息情况、饮食等8个因素与研究对象是否患有痛风/高尿酸血症存在相关性(P<0.05)。Logistic回归分析结果显示,经常饮酒者发生痛风/高尿酸血症的危险性是不经常饮酒者的0.683倍;周围人经常吸烟者发生痛风/高尿酸血症的危险性是不经常吸烟者的0.653倍;经常感觉疲劳者发生痛风/高尿酸血症的危险性是不经常感觉疲劳者的0.605倍;经常喝咖啡者发生痛风/高尿酸血症的危险性是不经常喝咖啡的者0.498倍;作息不规律者发生痛风/高尿酸血症的危险性是作息规律者的1.645倍;饮食不规律者发生痛风/高尿酸血症的危险性是饮食规律者的2.212倍。结论有效控制饮酒、减少周围人吸烟量、减少疲劳状态的发生、降低喝咖啡的频率等可以有效预防痛风/高尿酸血症的发生;规律的作息制度和饮食可在一定程度上预防痛风/高尿酸血症的发生。     

前言--重视老年高尿酸血症及痛风的防治(一)

原发性高尿酸血症和痛风是嘌呤代谢紊乱及(或)尿酸排泄减少所引起的一组代谢性疾病。其主要的临床特征为反复发作的关节炎、痛风石形成和痛风肾病等。痛风与高尿酸血症患者常伴有肥胖、高血压、糖代谢及脂代谢紊乱、凝血系统功能障碍等,这些疾病以胰岛素抵抗为其共同的病理生理     

痛风和高尿酸血症处理中的循证医学观点

随着人们生活水平的改善和生活方式的改变，我国患痛风或高尿酸血症的人数逐年增多。多项流行病学资料显示高尿酸血症和心血管疾病、高血压、肥胖、高脂血症、糖尿病经常同时出现，高尿酸血症与高血压发病密切相关，与心血管疾病的发生也有一定联系。然而，有不少医务人员和相关的高危人群对痛风和高尿酸血症的检查、监测、预防和治疗还是重视不够，在痛风预防和治疗上经常沿用一些经验疗法，     

原发性高尿酸血症和痛风分子遗传学研究进展

近年来原发性高尿酸血症和痛风的发病率逐年上升,高尿酸血症为痛风的早期阶段,长期高尿酸血症除易诱发痛风外,尚易累及肾脏和心脑血管系统,导致严重的肾脏及心脑血管疾病,但其遗传模式和易感基因尚不清楚。近年来的研究发现,嘌呤代谢过程中关键酶的缺陷及4个尿酸盐转运蛋白基因变异与高尿酸血症和痛风相关。本文对高尿酸血症和痛风的遗传模式、相关的易感基因及其染色体定位进行综述。     

无症状性高尿酸血症诊断及治疗

人类嘌呤代谢异常,尿酸(UA)生成过多和/或排泄减少,使血中UA浓度增高称高尿酸血症。它是痛风的重要生化基础。长期高尿酸血症可引起痛风,是痛风的临床诊断条件之一。部分高尿酸血症可多年无痛风症状,如无关节炎、痛风石或与尿酸盐有关的肾结石,故亦被称为无症状性高尿酸血症。约10％～20％高尿酸血症发展成痛风。高尿酸血症的发生率约5％。其范围为2％～18％,但随着我国人民生活水平的提高及寿命延长,其发生率正迅速增加。高尿酸血症不是痛风的代名词,但无症状性高尿酸血症则被认为是痛风发生的     

高尿酸血症与痛风患者并发肾结石的影响因素

目的收集高尿酸血症及痛风患者的临床资料及生化结果,分析高尿酸血症及痛风患者并发肾结石的危险因素。方法收集安徽省立医院门诊和住院及体检中心的痛风患者82例及高尿酸血症患者178例进行对照研究,所有患者统一问卷调查,收集一般资料及实验室检查数据,均进行双肾、输尿管、膀胱B超;采用组间对照及二元Logistic回归方法进行统计学分析。结果痛风组与高尿酸血症组肾结石发生率分别为36.6%和27.5%,两组比较差异无统计学差异(P>0.05)。痛风并发肾结石组相比痛风无肾结石组身高更高、体质量更重、病程更长、低密度脂蛋白(LDL)较高(P<0.05)。Logistic回归分析显示:病程>9年[OR=23.493,95%CI(2.824~195.421),P=0.003]、LDL≥4.1 mmol/L[OR=10.160,95%CI(1.218~84.747),P=0.032]是痛风患者发生肾结石的危险因素;痛风并发肾结石组相比高尿酸血症并发肾结石组有吸烟史、饮酒史的比例更高(P<0.05);所有高尿酸血症患者并发结石组相比高尿酸血症无肾结石组的体质量更重,BMI更高,舒张压更高(P<0.05)。结论高尿酸血症与痛风患者均有较高的肾结石发生率。病程>9年、LDL≥4.1 mmol/L是痛风患者肾结石发病的独立危险因素。高体质量及高体质量指数的痛风/高尿酸血症患者更应注意进行泌尿系结石的筛查以利于早期发现肾结石并及时治疗。     

高血压合并痛风和肾功能衰竭的治疗

老年高血压发病率较高。随着饮食的欧美化,老年高尿酸血症的发病率也增加,而且常合并肾功能和心血管功能异常。本文拟讨论老年高血压合并痛风和肾功能衰竭的治疗。饮食疗法高血压和痛风病人肥胖者多,应控制体重。但肾功衰竭后全身状态恶化,应以肾功衰竭饮食为主。肾功能低于30％时,以高热量、低蛋白、低盐饮食为主。药物治疗降压药:老年人降压治疗可用利尿剂、钙通道阻滞剂、交感神经抑制剂和ACE抑制剂。老年人尿液浓缩功能低下,利尿剂易致电解质紊乱,而且利尿剂可致细胞外液减少,有诱发脑梗塞和心肌梗     

Community based epidemiological study on hyperuricemia and gout in Kin-Hu, Kinmen

OBJECTIVE: This is a population survey conducted in 1991-92 among residents aged > or =30 years in Kin-Hu, Kinmen, with a 77.7% response rate to study the prevalence of hyperuricemia and hyperuricemia associated gout. A stratified analysis based on sex and age was used to assess the interaction and analyze the associated risk factors for hyperuricemia and gout. METHODS: Hyperuricemia was defined as uric acid > or =7.0 mg/dl for men and > or =6.0 mg/dl for women. Gout was clinically diagnosed by a senior rheumatologist based on patient's history and examination according to the clinical criteria of Wallace. Basic demographic and lifestyle variables as well as biochemical data were collected. RESULTS: The prevalence of hyperuricemia was 25.8% (391/1515) in men and 15.0% (250/1670) in women. The prevalence of gout among hyperuricemic subjects was 11.5% for men and 3% for women. According to age spectrum, the risk factor for hyperuricemia was hyperlipidemia in young adults (30-39 yrs); lifestyle and some clinical syndromes played a significant role in middle aged persons (40-59 yrs). The different risk factors between the sexes in middle age were alcohol consumption effect in men and menopause effect in women. Impaired renal function and use of diuretics became the important factors in the elderly (> or =60 yrs). The risk factors for gout among either the general population or subjects with hyperuricemia were concentration of serum uric acid, alcohol consumption, and central obesity. CONCLUSION: Risk factors for hyperuricemia tended to be different with respect to sex and age. Alcohol consumption and central obesity were independent predictors of gout among hyperuricemic subjects irrespective of uric acid level.     

The prevalence of hyperuricemia in a population of the coastal city of Qingdao, China

OBJECTIVE: Hyperuricemia and gout have shown an increase worldwide. Data are lacking for the prevalence of hyperuricemia and gout and their correlates in China. We studied the occurrence of these conditions in Chinese adults in the city of Qingdao. METHODS: A population-based cross-sectional survey for hyperuricemia and gout was performed among 2438 adults (1535 women, 903 men; aged 20-74 yrs) in 2002. Fasting serum uric acid (UA) and lipid profiles were determined, as well as height, weight, and blood pressure. Hyperuricemia was defined as serum UA levels >or= 420 micromol/l in men and >or= 360 micromol/l in women. Diagnosis of gout was self-reported. Complete biochemical and questionnaire data were available for analysis from 1303 women and 720 men. RESULTS: The age-standardized prevalence was 25.3% for hyperuricemia and 0.36% for gout in adults aged 20 to 74 years. Hyperuricemia was more prevalent in men than in women (32.1% vs 21.8%; p < 0.001). Age-adjusted mean serum UA level was 389.3 micromol/l in men and 315.7 micromol/l in women. Serum UA increased with age in women only (p for trend < 0.001). Body mass index and serum triglycerides had the strongest associations with serum UA in both genders, followed by alcohol drinking and diastolic blood pressure in men, and systolic blood pressure and total cholesterol in women. CONCLUSION: The prevalence of hyperuricemia in the urban adult population in Qingdao city is high, while the frequency of gout is lower. Obesity, hypertension, and dyslipidemia are the major factors associated with hyperuricemia in this study.     

Clinical aspects of monosodium urate monohydrate crystal deposition disease (gout)

Gout is a clinical syndrome with a limited range of manifestations arising as a result of the deposition of crystals of monosodium urate, the final product of purine metabolism in humans. Hyperuricemia is a common chemical aberration that is most often mild and remains asymptomatic. Thus, hyperuricemia should be distinguished from gout, even though urate supersaturation is necessary for the expression of gout. Uric acid overproduction and diminished renal uric acid excretion are the major mechanisms resulting in hyperuricemia, and an understanding of the basis of hyperuricemia in individual gout patients is an important step in determining appropriate treatment and in identifying underlying disorders, offending drugs and toxins, and inherited enzyme defects, all of which can result in hyperuricemia and gout. A scheme is presented for the evaluation of patients with new-onset gout, along with a discussion of the relationships between gout/hyperuricemia and a variety of metabolic disorders that are unusually prevalent in gouty populations.     

Gout and hyperuricemia

The prevalence of gout in the United States has been rising steadily for the past two decades. Hyperuricemia is considered a necessary but not sufficient precondition for gout. Known risk factors for gout include male sex, hypertension, renal insufficiency, obesity/weight gain, diuretic use, lead exposure, and family history. The association of gout and hyperuricemia with coronary artery disease is controversial. Current evidence from the Framingham Study suggests that gout is in fact an independent risk factor for CHD. These data suggest that patients with gout should be screened for modifiable risk factors for CHD, and that early intervention in such patients may be worthwhile. Finally, the effect of AHU as risk factor for CHD remains unclear but is probably a weak one.     

The benchmark dose estimation of reference levels of serum urate for gout

Clinical Rheumatology - Hyperuricemia is the main risk factor for gout. Although the threshold of hyperuricemia has been recommended, the reference levels of serum urate for gout have not been...     

Gout and the risk of acute myocardial infarction

OBJECTIVE: To determine if hyperuricemia and gouty arthritis are independent risk factors for acute myocardial infarction (MI) and, if so, whether they are independent of renal function, diuretic use, metabolic syndrome, and other established risk factors. METHODS: We performed multivariable logistic and instrumental variable probit regressions on data from the Multiple Risk Factor Intervention Trial (MRFIT). RESULTS: Overall, there were 12,866 men in the MRFIT who were followed up for a mean of 6.5 years. There were 118 events of acute MI in the group with gout (10.5%) and 990 events in the group without gout (8.43%; P = 0.018). Hyperuricemia was an independent risk factor for acute MI in the multivariable regression models, with an odds ratio (OR) of 1.11 (95% confidence interval [95% CI] 1.08-1.15, P < 0.001). In multivariable regressions in which the above risk factors were used as covariates, gout was found to be associated with a higher risk of acute MI (OR 1.26 [95% CI 1.14-1.40], P < 0.001). Subgroup analyses showed that a relationship between gout and the risk of acute MI was present among nonusers of alcohol, diuretics, or aspirin and among those who did not have metabolic syndrome, diabetes mellitus, or obesity. In separate analyses, a relationship between gout and the risk of acute MI was evident among those with and without those hyperuricemia. CONCLUSION: The independent risk relationship between hyperuricemia and acute MI is confirmed. Gouty arthritis is associated with an excess risk of acute MI, and this is not explained by its well-known links with renal function, metabolic syndrome, diuretic use, and traditional cardiovascular risk factors.     

Dietary and lifestyle changes associated with high prevalence of hyperuricemia and gout in the Shandong coastal cities of Eastern China

OBJECTIVE: To demonstrate the prevalence of hyperuricemia and gout associated with dietary and lifestyle changes and evaluate the implication of metabolic disorders to the development of hyperuricemia. METHODS: Data collected from 5,003 subjects randomly recruited from 5 coastal cities (Qingdao, Rizhao, Yantai, Weihai, and Dongying) of Shandong province in Eastern China were analyzed. RESULTS: Overall, the prevalence for hyperuricemia and gout in the studied populations was 13.19% and 1.14%, respectively. The prevalence was significantly higher in men as compared to women (18.32% vs 8.56% for hyperuricemia, 1.94% vs 0.42% for gout). Hyperuricemia was more common in men over age 30 and in women over age 50. A significant steady increase for the prevalence was noted as compared to the previous published data. Urban residents showed much higher prevalence of hyperuricemia as compared to rural residents (14.9% vs 10.1%, p = 0.004). Similarly, higher prevalence was noted in the developed city compared to the less developed city (18.02 vs 5.3%). These discrepancies were highly correlated with economic development as manifested by the increase of daily consumption of meat and seafood. Additionally, alcohol, overweight or obesity, hypertension, and abnormal triglycerides were highly associated with higher prevalence of hyperuricemia. Moreover, hyperuricemia is likely a risk factor for the development of diabetes mellitus. CONCLUSION: There was a remarkable increase for the prevalence of hyperuricemia and gout, which is highly correlated with the development of the economy as manifested by dietary and lifestyle changes.     

老年男性高尿酸血症临床特点及相关危险因素分析

目的了解老年男性高尿酸血症患者的临床特点和各种伴随疾病与之的相关性。方法收集2002年至2004年于解放军总医院住院的老年男性高尿酸血症患者和血尿酸正常患者各225例（合并糖尿病各110例）,对血尿酸及其影响因素进行横断面回顾性分析。结果高尿酸血症病例占同期住院老年男性患者的10．5％。高尿酸血症组合并肾功能异常远高于血尿酸正常组（27．6％vs6．2％）,差异有统计学意义（P=0．0000）。高尿酸血症组年龄、体质量、体质量指数、血压、甘油三酯、总胆固醇、空腹血糖、血肌酐、血尿素、肌酐清除率及高密度脂蛋白胆固醇与血尿酸正常组比较,差异具统计学意义（P〈O．01）,冠心病、高血压、高甘油三酯血症、肾功能异常等的患病率均高于血尿酸正常组（P〈0．01）。高尿酸血症组的血尿酸与年龄、体质量、体质量指数、血压、甘油三酯、总胆固醇、糖化血红蛋白、血肌酐、血尿素、肌酐清除率显著相关（P〈0．01）。结论老年高尿酸血症患病率高,以痛风发生为临床特征者不到10％,合并肾脏功能异常者是血尿酸正常组的4．5倍,且常伴随肥胖、糖、脂代谢紊乱和高血压,也是高血压、冠心病、糖尿病、高脂血症以及其他心、脑血管疾病的危险因素。对高尿酸血症患者应加以重视,尽早检出,综合评估心血管危险因素,及时治疗。