高尿酸血症、痛风和合并症

N. Shostak, N. Pravdyuk, T. K. Loginova, G. N. Lazarenko
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摘要

高尿酸血症最常合并脂质代谢紊乱,这是冠心病、中风、腹部肥胖、2型糖尿病、动脉高压、尿石症和慢性肾脏疾病的可改变风险因素。目前的数据表明,尿酸存在促炎、促氧化和血管收缩作用,这可能导致心脏代谢紊乱的发展。正常血清尿酸水平为360毫摩尔/升)和高心血管风险。目前可用的数据使我们能够考虑心血管高危患者的目标血清尿酸水平<5 mg/dl(<300 mmol/l),包括以下至少2个风险因素:高血压、糖尿病、血脂异常、中风、心脏病发作、慢性病肾脏,以及不具有这些风险因素的患者的目标血尿酸水平<6 mg/dl。选择降低尿酸盐的药物时要考虑伴随的病理学以及是否存在肝或肾功能障碍。黄嘌呤氧化酶抑制剂仍然是治疗高尿酸血症的一线药物。黄嘌呤氧化酶抑制剂的优越性是由于其对活性氧产生的潜在抑制作用及其抗氧化作用。痛风的治疗旨在改善急性和慢性关节炎的临床表现,防止关节炎复发和内脏损伤,并降低对共病病理产生负面影响的风险。临床医生面临着控制无症状高尿酸血症和痛风患者心血管疾病的任务。需要进一步的研究来调查痛风、高尿酸血症和心血管疾病风险增加之间的关系,并建立一个更完整的关于广泛共病患病率的图景。
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Hyperuricemia, gout and comorbidity
Hyperuricemia is most often combined with lipid metabolism disorders, modifiable risk factors for coronary heart disease, stroke, abdominal obesity, type 2 diabetes mellitus, arterial hypertension, urolithiasis, chronic kidney disease. Current data indicate the presence of pro-inflammatory, pro-oxidant and vasoconstrictive effects of uric acid, which may contribute to the development of cardiometabolic disorders. Normal serum uric acid levels are <6 mg / dl (<360 mmol / l) for women and <7 mg / dl (<420 mmol / l) for men. Currently, the role of hyperuricemia as an independent biomarker of the risk of cardiovascular events is emphasized. Both gout and subclinical hyperuricemia are associated with unfavorable cardiovascular outcomes. Patients should be informed about the risk factors of hyperuricemia; the need for lifestyle modification, diet compliance, and correction of drug therapy for comorbid conditions. According to international and domestic recommendations, urate-lowering therapy is indicated for asymptomatic hyperuricemia (>360 mmol / l) and high cardiovascular risk. The data available today allow us to consider the target serum uric acid level <5 mg / dl (<300 mmol / l) for patients with high cardiovascular risk, including at least 2 of the following risk factors: hypertension, diabetes mellitus, dyslipidemia, stroke, heart attack, chronic disease kidneys, and <6 mg / dl for patients who do not have these risk factors. The urate-lowering drug is selected taking into account the concomitant pathology and the presence or absence of liver or kidney dysfunction. Xanthine oxidase inhibitors are still the first-line drugs for the correction of hyperuricemia. The superiority of xanthine oxidase inhibitors is due to the potential inhibition of the production of reactive oxygen species and their antioxidant effect. Treatment of gout is aimed at achieving clinical improvement in acute and chronic arthritis, preventing recurrence of arthritis and damage to internal organs, as well as reducing the risks of negative effects on comorbid pathology. Clinicians are faced with the task of controlling cardiovascular diseases in patients with asymptomatic hyperuricemia and gout. Further studies are needed to investigate the relationship between gout, hyperuricemia and increased risk of cardiovascular diseases, as well as to establish a more complete picture of the prevalence of a wide range of comorbid conditions.
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