Zoccali Carmine, Maio Raffaele, Mallamaci Francesca, Sesti Giorgio, Perticone Francesco
CNR-IBIM Consiglio Nazionale delle Ricerche, Istituto di Biomedicina, delle Malattie Renali e dell'Ipertensione Arteriosa, c/o Divisione di Nefrologia e Dialisi, Ospedali Riuniti Via Vallone Petrara, Reggio Calabria, Italy.
J Am Soc Nephrol. 2006 May;17(5):1466-71. doi: 10.1681/ASN.2005090949. Epub 2006 Apr 12.
Recent epidemiologic and experimental evidence suggests that serum uric acid (UA) is an independent risk factor for cardiovascular and renal diseases. However, endothelial dysfunction is an early predictor of cardiovascular events, particularly in hypertensive patients. For assessment of the association between UA and endothelial function, 217 (108 men, 109 women; aged 48.0 +/- 10.6 yr) white never-treated hypertensive patients were studied. All patients underwent the following procedures: BP measurements, laboratory tests (C-reactive protein [CRP], insulin resistance by homeostasis model assessment, serum creatinine, and UA), and endothelial function evaluated by intra-arterial infusion of acetylcholine (ACh). Serum creatinine, CRP, and maximal vasodilatory response to ACh were related to the UA (all P < 0.0001). In the multiple regression analysis, serum UA ranked as the third correlate of peak of forearm blood flow predictor, after homeostasis model assessment and CRP. The data show an independent link between UA and endothelial function, also in a statistical model that included CRP. In conclusion, the data demonstrate an inverse and significant relationship between UA and ACh-stimulated vasodilation in patients with uncomplicated, untreated essential hypertension, independent of traditional cardiovascular risk factors. Probably, the chronic inflammation that was documented in these patients may be considered the mechanistic link between serum UA and vascular damage.
近期的流行病学和实验证据表明，血清尿酸（UA）是心血管疾病和肾脏疾病的独立危险因素。然而，内皮功能障碍是心血管事件的早期预测指标，尤其是在高血压患者中。为了评估UA与内皮功能之间的关联，我们对217名（108名男性，109名女性；年龄48.0±10.6岁）未经治疗的白人高血压患者进行了研究。所有患者均接受了以下检查：血压测量、实验室检查（C反应蛋白[CRP]、通过稳态模型评估的胰岛素抵抗、血清肌酐和UA），以及通过动脉内注射乙酰胆碱（ACh）评估内皮功能。血清肌酐、CRP和对ACh的最大血管舒张反应均与UA相关（所有P<0.0001）。在多元回归分析中，血清UA在稳态模型评估和CRP之后，位列前臂血流预测峰值的第三相关因素。数据显示，在包含CRP的统计模型中，UA与内皮功能之间也存在独立关联。总之，数据表明，在无并发症、未经治疗的原发性高血压患者中，UA与ACh刺激的血管舒张之间存在反向且显著的关系，且独立于传统心血管危险因素。这些患者中记录到的慢性炎症可能被认为是血清UA与血管损伤之间的机制联系。
