Arlet J-B, Ribeil J-A, Chatellier G, Pouchot J, de Montalembert M, Prié D, Courbebaisse M
Hôpital européen Georges-Pompidou, université Paris-Descartes, Paris cedex 15, France.
Rev Med Interne. 2012 Jan;33(1):13-7. doi: 10.1016/j.revmed.2011.07.002. Epub 2011 Sep 9.
Hyperuricemia has been reported to be a common feature of sickle cell disease occurring between 32 to 41% of the patients, in studies conducted during the 1970's. Since then, this notion has been rarely challenged. The objective of this study was to assess the prevalence of hyperuricemia and gout in adult patients with sickle cell disease in France.
Between May 2007 and March 2009, serum and urinary urate concentration, creatininemia and hemogram were prospectively assessed in all consecutive sickle cell patients, followed in our sickle cell disease centre. All subjects were in a clinically steady state. Clinical acute gout history was also recorded.
Sixty-five patients (mean age 31±10.3 years) were investigated. Mean uric acid serum level was 281.6±74μmol/L. Hyperuricemia was evidenced in six patients only (9.2%) (95% IC: 3.5-19.0). None of the patient had a medical history of acute gout. Patients in the higher serum uric acid tertile concentration had higher serum creatinine level (62.3±17.1μmol/L vs 51.5±12.6μmol/L, P<0.01), lower fractional excretion of urate (4.5% vs 6.8%, P<0.03) and higher reticulocyte count (median 219500/mm(3) vs 144000/mm(3), P=0.08) compared to the other patients.
Hyperuricemia and gout are not a clinical problem in sickle cell disease in our country. Nevertheless, our findings indicate that kidney function has to be fully explored if serum uric acid level is elevated or significantly deteriorates during follow-up. Serum uric acid level could be an early marker of renal dysfunction in sickle cell disease patients.
据报道，高尿酸血症是镰状细胞病的一个常见特征，在20世纪70年代进行的研究中，32%至41%的患者会出现该症状。从那时起，这一观点很少受到质疑。本研究的目的是评估法国成年镰状细胞病患者中高尿酸血症和痛风的患病率。
2007年5月至2009年3月期间，对在我们镰状细胞病中心接受随访的所有连续镰状细胞病患者进行前瞻性评估，检测血清和尿尿酸浓度、血肌酐水平及血常规。所有受试者临床状态稳定。同时记录临床急性痛风病史。
共调查了65例患者（平均年龄31±10.3岁）。血清尿酸平均水平为281.6±74μmol/L。仅6例患者（9.2%）出现高尿酸血症（95%置信区间：3.5 - 19.0）。所有患者均无急性痛风病史。血清尿酸浓度处于最高三分位数的患者与其他患者相比，血清肌酐水平更高（62.3±17.1μmol/L对51.5±12.6μmol/L，P<0.01），尿酸排泄分数更低（4.5%对6.8%，P<0.03），网织红细胞计数更高（中位数219500/mm³对144000/mm³，P = 0.08）。
在我国，高尿酸血症和痛风并非镰状细胞病的临床问题。然而，我们的研究结果表明，如果随访期间血清尿酸水平升高或显著恶化，必须全面评估肾功能。血清尿酸水平可能是镰状细胞病患者肾功能障碍的早期标志物。
