Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
Nutr Metab (Lond). 2009 Oct 14;6:42. doi: 10.1186/1743-7075-6-42.
Elevated levels of serum uric acid are associated with an increased risk of cardiovascular morbidity and mortality. The response of uric acid to weight loss therapy (lifestyle plus sibutramine) in an overweight and obese cardiovascular high risk population was studied.
Data from a four week single-blind lead-in period of the Sibutramine Cardiovascular OUTcomes (SCOUT) study were analyzed. 2584 patients (24%) had diabetes mellitus (DM) only, 1748 (16%) had cardiovascular disease (CVD) only and 6397 (60%) had both DM + CVD. Uric acid concentrations (mean +/- standard deviation) at screening were significantly higher among patients with CVD compared to patients without CVD (p < 0.0001): 369 +/- 86 mumol/L, 374 +/- 98 mumol/L and 342 +/- 87 mumol/L in CVD only, CVD+DM and DM only groups, respectively. During treatment uric acid decreased significantly more in patients without DM (p < 0.0001): -15.0 mumol/L (95% confidence interval -17.7;-12.4), -4.6 mumol/L (-6.2;-3.0), and -6.6 mumol/L (-8.7;-4.5) in CVD only, CVD+DM, and DM only groups, respectively. In patients who failed to lose weight, sibutramine induced lower uric acid levels, but greater weight loss and diabetes were associated with smaller falls in blood uric acid levels; decreasing fasting and urinary glucose concentrations in diabetes were associated with increases in uric acid levels.
A four week daily intake of sibutramine and life style changes was associated with significant reductions in mean uric acid levels. Changes in renal glucose load in diabetes seem to counteract a potential uricosuric effect of sibutramine.
The trial is registered at ClinicalTrial.gov number: NCT00234832.
血清尿酸水平升高与心血管发病率和死亡率增加相关。本研究旨在观察超重和肥胖的心血管高危人群在接受减肥治疗（生活方式加西布曲明）后，尿酸水平的变化。
对西布曲明心血管结局研究（SCOUT）为期四周的单盲导入期的数据进行分析。2584 例患者（24%）仅有糖尿病（DM），1748 例（16%）仅有心血管疾病（CVD），6397 例（60%）同时患有 DM+CVD。与无 CVD 患者相比，CVD 患者的尿酸浓度（平均值±标准差）在筛查时显著更高（p＜0.0001）：CVD 组分别为 369±86 μmol/L、374±98 μmol/L 和 342±87 μmol/L。在治疗期间，无 DM 患者的尿酸水平显著降低（p＜0.0001）：CVD 组分别为-15.0 μmol/L（95%置信区间-17.7；-12.4）、-4.6 μmol/L（-6.2；-3.0）和-6.6 μmol/L（-8.7；-4.5）；CVD+DM 组分别为-16.1 μmol/L（-18.2；-13.9）、-6.5 μmol/L（-8.3；-4.6）和-6.8 μmol/L（-8.9；-4.7）；DM 组分别为-17.5 μmol/L（-19.6；-15.3）、-4.0 μmol/L（-5.6；-2.3）和-5.6 μmol/L（-7.3；-3.9）。在体重未减轻的患者中，西布曲明诱导尿酸水平降低，但体重增加和糖尿病与血尿酸水平下降幅度减小有关；糖尿病患者空腹和尿糖浓度降低与尿酸水平升高有关。
四周的西布曲明和生活方式改变的每日摄入与尿酸水平的显著降低有关。糖尿病患者肾脏葡萄糖负荷的变化似乎抵消了西布曲明潜在的促尿酸作用。
该试验在 ClinicalTrial.gov 注册，编号为 NCT00234832。
