Department of Rheumatology, Counties Manukau District Health Board, , Auckland, New Zealand.
Ann Rheum Dis. 2014 May;73(5):797-802. doi: 10.1136/annrheumdis-2013-203970. Epub 2013 Nov 19.
Weight loss leads to reduced serum urate (SU) in people with obesity. However, the clinical relevance of such reductions in SU is unknown. This study examined the impact of non-surgical weight loss and bariatric surgery on SU targets in people with morbid obesity and diabetes.
The study was a single-centre, prospective study of 60 people with type 2 diabetes and body mass index ≥35 kg/m(2). Following 6 months of non-surgical weight loss, all participants had laparoscopic sleeve gastrectomy, with a further 1 year of follow-up. Serial SUs were measured throughout the study.
Participants experienced mean (SD) weight loss of 5.5 (4.1) kg prior to surgery and 34.3 (11.1) kg following surgery. SU did not change following non-surgical weight loss (0.38 (0.09) mmol/L at baseline and 0.38 (0.10) mmol/L at follow-up), but increased to 0.44 (0.15) mmol/L in the immediate postoperative period and reduced to 0.30 (0.08) mmol/L 1 year after surgery (p<0.05 for both compared with baseline). Baseline SU, cessation of diuretics, female sex and change in creatinine independently predicted change in SU at the final visit. In participants without gout, SU above saturation levels (≥0.41 mmol/L) were present in 19/48 (40%) at baseline and 1/48 (2%) 1 year after surgery (p<0.0001). In participants with gout, SU above therapeutic target levels (≥0.36 mmol/L) were present in 10/12 (83%) at baseline and 4/12 (33%) 1 year after surgery (p=0.031).
Clinically relevant reductions in SU occur following bariatric surgery in people with diabetes and WHO class II or higher obesity.
减肥可降低肥胖人群的血清尿酸（SU）水平。然而，SU 降低的临床意义尚不清楚。本研究旨在探讨非手术减肥和减重手术对肥胖合并糖尿病患者 SU 目标的影响。
该研究为单中心前瞻性研究，共纳入 60 例 BMI≥35kg/m²且患有 2 型糖尿病的患者。所有患者先接受 6 个月的非手术减肥，然后行腹腔镜袖状胃切除术，并进行为期 1 年的随访。整个研究过程中连续测量 SU。
患者手术前平均（SD）体重减轻 5.5（4.1）kg，手术后体重减轻 34.3（11.1）kg。非手术减肥后 SU 无变化（基线时为 0.38（0.09）mmol/L，随访时为 0.38（0.10）mmol/L），但术后即刻升高至 0.44（0.15）mmol/L，术后 1 年降至 0.30（0.08）mmol/L（与基线相比，P<0.05）。基线 SU、利尿剂停药、女性和肌酐变化可独立预测最终访视时 SU 的变化。在无痛风的患者中，基线时 SU 超过饱和水平（≥0.41mmol/L）的患者有 19/48（40%），术后 1 年有 1/48（2%）（P<0.0001）。在有痛风的患者中，基线时 SU 超过治疗目标水平（≥0.36mmol/L）的患者有 10/12（83%），术后 1 年有 4/12（33%）（P=0.031）。
糖尿病和世界卫生组织（WHO）肥胖分类 II 级或更高级别的肥胖患者行减重手术后，SU 水平显著降低，且具有临床意义。
