血清尿酸与高尿酸血症相关疾病

尿酸是人体嘌呤碱基分解代谢终产物,经肾脏排泄。体内尿酸生成超过肾脏排泄时血清尿酸会显著升高,造成高尿酸血症。高尿酸血症与痛风、心血管疾病、肿瘤裂解综合征及肾脏疾病的引发或加剧密切相关。本文对血清尿酸的临床意义进行综述。     

The association of vitamin C,alcohol, coffee,tea, milk and yogurt with uric acid and gout

About 2500 years ago, gout was observed by Hippocrates and many people suffered severe pain and deformity. Lifestyle and diet play a significant role in gout and serum uric acid levels. Epidemiological and research studies have supported this evidence. Many recommendations and guidelines from different parts of the world mention the impact of diet on gout. Recently, new research has shown associations between vitamin C, alcohol, coffee, tea, milk and yogurt with uric acid and the risk of gout. Our review summarizes recently published research regarding dietary impact on the risk of gout and serum uric acid levels.     

Effect of urate‐lowering therapy on the velocity of size reduction of tophi in chronic gout

Objective

The optimal serum urate levels necessary for elimination of tissue deposits of monosodium urate in patients with chronic gout is controversial. This observational, prospective study evaluates the relationship between serum urate levels during therapy and the velocity of reduction of tophi in patients with chronic tophaceous gout.

Method

Sixty‐three patients with crystal‐confirmed tophaceous gout were treated with allopurinol, benzbromarone, or combined therapy to achieve serum uric acid levels less than the threshold for saturation of urate in tissues. The tophi targeted for evaluation during followup were the largest in diameter found during physical examination.

Results

Patients taking benzbromarone alone or combined allopurinol and benzbromarone therapy achieved faster velocity of reduction of tophi than patients taking allopurinol alone. The velocity of tophi reduction was linearly related to the mean serum urate level during therapy. The lower the serum urate levels, the faster the velocity of tophi reduction.

Conclusion

Serum urate levels should be lowered enough to promote dissolution of urate deposits in patients with tophaceous gout. Allopurinol and benzbromarone are equally effective when optimal serum urate levels are achieved during therapy. Combined therapy may be useful in patients who do not show enough reduction in serum urate levels with single‐drug therapy.

     

氯沙坦（科素亚）促尿酸排泄作用的临床研究

目的 尿酸是高血压病的危险因素之一,其主要表现为血尿酸（SUA）升高。由于高血压病人肾功能减退或肾血流量下降,故高血压患中高尿酸血症较正常血压多。高血压患中,伴有高尿酸血症心血管事件增多。在高血压病的治疗中,特异性阻断1型血管紧张素Ⅱ（AT1)受体的血管紧张素Ⅱ（ATⅡ）拮抗剂－氯沙坦（科素亚）。业已显示它是一个有效的降血压药物,且有促尿酸排泄作用。本收集了60例本院住院高血压病（1－2级）病人。随机抽取30例作治疗组,单独应用氯沙坦（科素亚）治疗。另30例作对照组。观察表明,氯沙坦（科素亚）可显促尿酸排泄,降低血尿酸水平。     

Excellent response to the clinical treatment of tophaceous gout

Gout continues to be a health problem around the world, and the treatment may turn into a real challenge when the patient presents a certain degree of chronic renal failure (CRF). We discuss a case of tophaceous gout in a 68-year-old male patient without urolithiasis and with uric acid (UA) underexcretion and CRF (creatinine clearance of 42 ml/min). Uricosuric treatment with benzbromarone and urinary alkalinization was administered, and acute gouty attacks improved substantially. Subsequently, allopurinol was added to the treatment to accelerate tophi reduction in the hands, feet, elbows and knees. After 30 months of treatment, serum UA declined from 10 to 3.2 mg/dl. Urinary UA excretion of 0.44 g/24 h in the baseline rose to 0.85 g/24 h, returning to the baseline value after 30 months. UA clearance tripled, rising from 3.05 ml/min before treatment to 9.48 ml/min, and remained at this level. It is worth stressing that even in cases of severe tophaceous gout, the response to clinical treatment may be satisfactory with substantial reduction of tophi and full acute gouty attack remission even in patients presenting a certain degree of CRF.     

Gouty flexor tenosynovitis of the hand mimicking atypical mycobacterial infection

A 50-year-old Japanese fish dealer presented with painful and swollen fingers. Infectious flexor tenosynovitis with Mycobacterium marinum was suspected. Range of motion was restored after tenosynovectomy and after ofloxacin and clarithromycin were administered. Two years after the operation, the patient presented again with acute inflammation in the same fingers. Histopathological examination revealed gouty tenosynovitis. The preconception that mycobacterial infection occurs often in fish dealers caused us to miss the correct diagnosis of gouty tenosynovitis.     

血尿酸水平与主动脉夹层的相关性研究

目的探讨血尿酸水平与主动脉夹层的关系。方法病例组为2009—2012年间124例确诊为主动脉夹层患者,对照组为在性别、年龄、高血压史及体重指数等与病例组相匹配的、同期于我院体检者73例。收集患者的相关临床资料及血尿酸指标,进行相关的统计分析。结果主动脉夹层组血尿酸水平较对照组显著增高,分别为（345．8±119．4）mmol／L和（311．1±66．0）mmol／L（P=-0．006）。主动脉夹层组尿酸水平在性别、年龄以及病变的急慢性之间均无显著差异,但吸烟、合并高血压者的尿酸水平显著高于非吸烟、无高血压患者;非马凡综合征诱发的主动脉夹层组患者的血尿酸水平明显高于马凡综合征合并主动脉夹层组患者,分别为（348．0±120．5）mmol／L和（280．1±56．6）mmol／L（P〈0．05）。结论血高尿酸水平与主动脉夹层的发生存在明显的相关性,且是主动脉夹层发生、发展的可能机制之一。     

血清尿酸水平与代谢综合征相关

目的探讨血清尿酸水平与中国人群代谢综合征的关系。方法入选960例无心血管病症状的普通社区人群,男751人,女209人,平均年龄41.27岁,所有研究对象进行了详细的问卷调查和体检。计算分性别的血清尿酸四分位数,将研究对象分成4组,观察各组代谢综合征发生情况。结果男性中,代谢综合征患者的血清尿酸水平359.5±66.lumol/L,显著高于非代谢综合征患者319.4±66.7umol/L。女性中,代谢综合征患者的血清尿酸水平304.6±60.7umol/L,显著高于非代谢综合征患者242.9.4±52.9umol/L。血清尿酸四分位分组间代谢综合征的发生率分别为5.8%,8.2%,16.7%和24.1%。在校正了年龄、性别、吸烟状况,饮酒状况,糖尿病家族史、血压、血脂、腰围等混杂因素后,血清尿酸高的对象发生代谢综合征的危险是血清尿酸低的2.24（1.05-4.76）倍,P=0.036。结论血清尿酸水平与代谢综合征显著相关。     

Serum uric acid and its change with the risk of type 2 diabetes: A prospective study in China

ObjectiveTo assess the association of baseline uric acid levels and their changes from baseline to Year 1 with the risk of type 2 diabetes.Research design and methodsThis study cohort included 9471 subjects without a history of diabetes at baseline. The incident diabetes was diagnosed according to the American Diabetes Association standard.ResultsDuring a mean follow-up of 2.9 years, we identified 762 type 2 diabetes cases. Multivariate-adjusted hazard ratios (HRs) of diabetes across baseline tertiles of serum uric acid were 1.00, 1.15, and 1.32 (P for trend = 0.018), respectively. Participants with hyperuricemia compared with those without had a 1.20-fold (95% confidence interval [CI] 1.01−1.44) risk of diabetes. When uric acid was examined as a continuous variable, multivariable-adjusted HR of diabetes for each 1 mg/dL (60 μmol/L) increase in serum uric acid was 1.09 (95% CI 1.03−1.15). Compared with subjects with stable serum uric acid from baseline to Year 1 (±10%), those with uric acid gain ≥30% had a 30% (95% CI 1.01–1.79) increased risk of diabetes and those with uric acid loss ≥10% had a 21% (95% 0.62−0.99) decreased risk of diabetes. This positive association between baseline serum uric acid and diabetes risk was consistent among subjects younger and older than 45 years, non-obese and obese participants, and men.ConclusionsHigh level of baseline serum uric acid and serum uric acid gain from baseline to Year 1 are associated with an increased risk of type 2 diabetes among Chinese adults.     

La maladie de Kikuchi-Fujimoto

Kikuchi-Fujimoto disease is a necrotizing lymphadenitis, involving young patients, predominantly females. Lymphadenopathy is usually localized, particularly in the cervical area, mostly unilateral and tender. Fever is present in one third of cases. Associated skin lesions, arthralgia, myalgia, splenomegaly or hepatomegaly are rare. Laboratory evaluation shows a slight increase of erythrocyte sedimentation rate and leukopenia. Kikuchi-Fujimoto has been reported in association with other diseases, including systemic lupus, Still's disease, hemophagocytosis, pregnancy, other autoimmune diseases, and cancer. A viral or bacterial origin has been suspected but not confirmed. Lymph node biopsy allows the diagnosis and shows necrotizing lymphadenitis with acidophil necrosis, CD68+ histiocyte infiltrate, presence of plasmacytoid monocytes, multiple apoptotic cells (CD8+ T cell) with nuclear dust, immunoblastic reaction and the absence of neutrophils or eosinophils. The disease course is usually spontaneously favourable in few weeks or months, requiring corticosteroids only occasionally.     

La maladie de Castleman

Castleman's disease, also called angiofollicular lymph node hyperplasia was first described as a distinct entity by Castleman et al in 1956. Two forms are now described a localized and a multicentric. The clinical and biological signs are varied and heterogeneous, and the diagnostic is made on the histologic examination. This atypical lymphoproliferalive disorder is of unknow origin, but interleukin 6 play a central pan in this disease. Despite the benignity of this “prelymphoma state”, an agressive course with poor prognosis occur usually in the multicentric form. Malignant lymphomas and Kaposi's sarcoma have been associated with Castleman's disease.     

La maladie de Willebrand

Von Willebrand factor is involved in primary hemostasis (adhesion of platelets to subendothelium and platelet aggregation) and acts as the carrier of coagulation factor VIII. Von Willebrand disease, resulting from a quantitative or qualitative defect of this factor, is the most frequent inherited bleeding disorder. It is mainly responsible for symptoms such as mucocutaneous bleeding and excessive bleeding after trauma or invasive procedures, but can also cause gastro-intestinal bleeding or hemarthrosis in the most severe forms of the disease. There are numerous causes of physiological variation of von Willebrand factor plasma levels which can be responsible for diagnostic difficulty or changes in symptoms over time. Diagnosis relies primarily on clinical symptoms but requires the use of several laboratory analyses: von Willebrand factor activity and antigen testing and factor VIII activity. More specialized assays allow classification of the disease in various types and subtypes which imply different management strategies (types 1, 2A, 2B, 2M, 2N, and 3). Treatment is based on desmopressin, responsible for an increase in plasma concentration of von Willebrand factor, and plasma-derived von Willebrand factor concentrates which can be combined with factor VIII.     

Gouty flexor tenosynovitis of the hand mimicking atypical mycobacterial infection

Abstract

A 50-year-old Japanese fish dealer presented with painful and swollen fingers. Infectious flexor tenosynovitis with Mycobacterium marinum was suspected. Range of motion was restored after tenosynovectomy and after ofloxacin and clarithromycin were administered. Two years after the operation, the patient presented again with acute inflammation in the same fingers. Histopathological examination revealed gouty tenosynovitis. The preconception that mycobacterial infection occurs often in fish dealers caused us to miss the correct diagnosis of gouty tenosynovitis.     

青岛市社区中老年人群高尿酸血症流行病学调查

目的调查中老年人群高尿酸血症（HUA）的患病率以及影响因素。方法分层随机整群抽样,横断面调查青岛市湛山社区40-74岁居民1706名,问卷调查,体格检查,检测空腹血尿酸（SUA）、血脂、血糖等。结果（1）调整年龄后SUA水平均值为342.6μmol/L（男388.0μmol/L,女317.6μmol/L）,同年龄组男性SUA显著高于女性,仅女性SUA水平随年龄增长呈总体上升趋势（P〈0.01）。（2）HUA的粗患病率为25.1%。按2000年全国人口普查年龄构成计算,男女HUA标化患病率分别为29.5%和20.5%%,标化患病率分别为23.3%。（3）多因素线性回归结果表明,BMI、TG、BP、饮酒、增龄与SUA相关性最高。结论青岛市社区居民HUA患病率较高,肥胖、脂代谢异常、高血压、饮酒、高嘌呤饮食和增龄是影响SUA的重要相关因素。     

正常高值血压与血尿酸的相关性观察

目的:探讨正常高值血压(120~139/80~89mmHg)与血尿酸(UA)的相关性。方法:选出正常高值血压患者96例,正常血压者72例作为对照组,测全部受试对象的血UA水平,并进行比较。结果:正常高值血压组血UA水平显著高于对照组[(327.48±72.21)∶(277.99±73.34)μmol/L,P<0.01]。正常高值血压组的高UA血症患病率为13.54%,显著高于对照组的4.17%,(P<0.01)。相关分析显示:血UA水平与收缩压、舒张压均呈正相关(r=0.188,0.317,P<0.05,P<0.01)。结论:正常高值血压者已有血UA升高,血UA是高血压及心血管的危险因素。     

Higher consumption of sugar-sweetened soft drinks increases the risk of hyperuricemia in Korean population: The Korean Multi-Rural Communities Cohort Study

Objective

The clinical implication of sugar-sweetened soft drinks on the risk of hyperuricemia has increased, especially in Western population studies. The aim of this study is to clarify the association between sugar-sweetened soft drinks and fruit drinks made from oranges and apples and the risk of hyperuricemia in the Korean Multi-Rural Communities Cohort.

Methods

A total of 9400 subjects were enrolled in the Korean Multi-Rural Communities Cohort Study, and a cross-sectional analysis was performed. Five quintiles (Q1–Q5) according to consumption of soft drinks and other fruit/fruit juices were classified and then categorized into three groups (Q1–Q3, Q4, and Q5) to assess the risk of hyperuricemia. Information on dietary intake was collected by well-trained interviewers using validated food frequency questionnaires.

Results

Higher consumption of sugar-sweetened soft drinks (Q5) increased the risk of hyperuricemia in males (adjusted OR = 1.35, 95% CI: 1.07–1.71) with a linear trend (p for trend = 0.01) and in females (adjusted OR = 1.40, 95% CI: 1.03–1.90) with no linear trend (p for trend = 0.09), compared to lower consumption (Q1–Q3). However, there were no significant differences of serum uric acid level according to the three categories of soft drink consumption, Q1–Q3, Q3, and Q5, in males (p = 0.21) or in females (p = 0.16), whereas all subjects showed statistical significance of serum uric acid level within the categories (p < 0.001). Estimated amount of soft drink intake was associated with serum uric acid level in males (β = 0.001; p = 0.01) but not in females (β = 0.0005; p = 0.10).

Conclusion

Higher consumption of sugar-sweetened soft drinks increased the risk of hyperuricemia in the Korean population, showing a differential linear trend for hyperuricemia according to gender.     

卡托普利对老年高血压患者血尿酸的影响

目的探讨卡托普利对老年高血压患者血尿酸的影响。方法观察55例老年高血压患者服药前后血尿酸、尿素氮(BUN)、肌酐(Cr)、血钾(K