糖尿病患者血清尿酸水平检测及其价值

目的　通过检测糖尿病 (diabetesmellitus,DM )患者血尿酸 (UA)水平 ,探讨其与并发血管疾病的关系及价值。方法　血UA采用尿酸酶法测定。对 6 8例DM患者 (36例并发血管疾病 ,其中 2 1例发生微血管并发症 ,15例发生大血管病变 )和 5 0例健康成人取肘静脉血检测UA水平。结果　DM各组血清UA水平显著高于健康成人组(P<0 .0 1) ;大、微血管病变组与无并发症DM患者血清UA水平差异有统计学意义 (P <0 .0 1) ;微血管病变组血清UA水平与大血管病变组比较 ,差异无统计学意义 (P >0 .0 5 ) ;以大于正常 x± 2s值为阳性判定标准 ,大、微血管病变组阳性率为 80 .5 6 % (2 9/ 36 ) ,无并发症组阳性率为 6 .2 5 % (2 / 32 ) ,有、无并发症组阳性率差异有统计学意义 (χ2 =2 9.6 70 ,P <0 .0 1)。阳性预测值 93.5 5 % (2 9/ 31) ,阴性预测值 81.0 8% (30 / 37) ,敏感性 80 .5 6 % (2 9/ 36 ) ,特异性93.75 % (30 / 32 )。结论　DM患者病情与血清UA水平相关 ,UA定量测定对DM患者并发血管疾病有判断价值     

健康体检人群尿酸水平对血细胞参数的影响

目的：探讨健康体检人群尿酸水平对红细胞(red blood cell,RBC)、白细胞(white blood cell,WBC)及血小板(platelets,PLT)各参数的影响。方法选择健康体检人群1037例作为研究对象,按性别及尿酸(uric acid, UA)水平分为4组,其中 A 组为男性高尿酸血症202例,B 组为男性 UA 正常320例,C 组为女性高尿酸血症170例, D 组为女性 UA 正常345例。检测每个研究对象 UA、RBC、血红蛋白(hemoglobin,HB)、红细胞比容(hematocrit, HCT)、红细胞体积分布宽度(red cell distribution width,RDW)、PLT、血小板压积(plateletcrit,PCT)、血小板分布宽度(platelet distribution width,PDW)、WBC。结果高尿酸血症组在 UA、RBC、RDW、PLT、PCT、HCT、HB 水平明显高于 UA 正常组(P <0.01)。UA 水平与 HCT、HB、RBC、RDW、WBC 有一定正相关(r =0.298、0291、0.27、0.19和0.081,P <0.01),与 PLT 相关参数无相关性。结论随着 UA 浓度升高,血细胞各项参数有不同程度的升高。     

Detection of hyponatremia in the PACU.

Fluid and electrolyte management is an important part of PACU nursing care. Any alteration in fluid and electrolytes, especially in the vulnerable elderly population, can be catastrophic. An assessment of hyponatremia following transurethral resection of the prostate requires that the PACU nurse be diligent in discovering the etiology of unexpected mental status changes.     

Uric acid lithiasis associated with altered kinetics of hypoxanthine-guanine phosphoribosyltranferase.

1. A patient is described who had uric acid calculi which obstructed both kidneys. Serum uric acid was 34 mg/100 ml upon admission to hospital, and evidence of precipitation of uric acid in joints was obtained. 2. Total activity of hypoxanthine-guanine phosphoribosyltransferase in erythrocytes lysates from this patient was 44% of normal. Kinetic studies revealed that the apparent Michaelis constant of this enzyme for phosphoribosyl pyrophosphate was elevated 15-fold, while these values for hypoxanthine and guanine were in the normal range.     

Chlorpropamide-induced hyponatremia in the veteran population.

OBJECTIVE: To determine the incidence and possible risk factors associated with chlorpropamide (CPA)-induced hyponatremia in the veteran population. DESIGN: Retrospective cohort study. SETTING: Federal tertiary care medical center. PATIENTS: Veterans receiving CPA from our facility with at least one serum sodium concentration below 135 mmol/L within the past year were eligible. A randomly selected control group consisting of patients taking CPA with normal sodium concentrations was also chosen. One hundred forty-five of 799 patients who had received CPA were included in the study. RESULTS: The average daily dose of CPA was 425 +/- 207 mg (+/- SD). The incidence of hyponatremia associated with CPA was 7.1 percent (57/799 patients). The majority of patients were mildly hyponatremic (48/57 patients, 84 percent) with serum sodium concentrations between 130 and 134 mmol/L. The incidence of CPA-induced syndrome of inappropriate antidiuretic hormone was 2.1 percent. Concurrent angiotensin-converting enzyme (ACE) inhibitor use was identified as a risk factor; thiazide diuretic use was not. CONCLUSIONS: The incidence of hyponatremia related to CPA use in elderly veterans is consistent with other reports in the literature. ACE inhibitors may be a predisposing factor for CPA-induced hyponatremia.     

Uric acid reduces exercise-induced oxidative stress in healthy adults

Uric acid (UA) possesses free-radical-scavenging properties, and systemic administration is known to increase serum antioxidant capacity. However, it is not known whether this protects against oxidative stress. The effects of raising UA concentration were studied during acute aerobic physical exercise in healthy subjects, as a model of oxidative stress characterized by increased circulating 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha) concentrations. Twenty healthy subjects were recruited to a randomized double-blind placebo-controlled crossover study, and underwent systemic administration of 0.5 g of UA in 250 ml of 0.1% lithium carbonate/4% dextrose vehicle or vehicle alone as control. Subjects performed high-intensity aerobic exercise for 20 min to induce oxidative stress. Plasma 8-iso-PGF2alpha concentrations were determined at baseline, after exercise and after recovery for 20 min. A single bout of high-intensity exercise caused a significant increase in plasma 8-iso-PGF2alpha concentrations from 35.0 +/- 4.7 pg/ml to 45.6 +/- 6.7 pg/ml (P<0.01). UA administration raised serum urate concentration from 293 +/- 16 to 487 +/- 16 micromol/l (P<0.001), accompanied by increased serum antioxidant capacity from 1786+/-39 to 1899 +/- 45 micromol/l (P<0.01). UA administration abolished the exercise-induced elevation of plasma 8-iso-PGF2alpha concentrations. High UA concentrations are associated with increased serum antioxidant capacity and reduced oxidative stress during acute physical exercise in healthy subjects. These findings indicate that the antioxidant properties of UA are of biological importance in vivo.     

Uric acid estimation: a comparison of the manual uricase-UV and the phosphotungstate auto-analyzer methods.

1. Uric acid estimations by the uricase-UV and the autoanalyzer colorimetric procedures were compared. 2. At all levels of serum uric acid concentration measured, results with the uricase-UV method were significantly lower than those with the phosphotungstate method. 3. The data indicate that the critical uric acid level (measured by the autoanalyzer) at which allopurinol, uricosuric, and other agents are instituted should be decreased approximately 10 per cent when determinations are done by the uricase method.     

Uric acid, a neglected molecule--the value of imaging

Imaging plays a key role in two longterm effects of hyperuricemia: those on the urinary tract and on the skeletal system. This overview concentrates on the diagnosis of urinary stones and of musculoskeletal gout. Urinary stones are negative on radiography, i.e., they cannot be differentiated from the surrounding tissues, and even at intravenous urography only non specific filling defects are shown that may be hard to differentiate from blood clots and papillary necrosis whereas computed tomography without a contrast agent is highly sensitive in detecting all types of stones whether negative or positive at radiography. Gout of the musculoskeletal system usually manifests as an acute gouty arthritis after a long-standing asymptomatic hyperuricemia. An intercritical phase may follow before new acute attacks and--in up to 50%--chronic gout develop. During acute gouty arthritis imaging is non-specific. The distribution pattern, the relation of soft tissue changes and osteolytic paraarticular changes, calcifications and the lack of osteoporosis are a typical, nearly pathognomonic constellation of chronic tophaceous gout. In selected cases CT or MRI may add critical local information.