无症状性高尿酸血症的治疗以预防痛风性关节炎、肾脏疾病和心血管事件：一项系统文献综述
Treatment of asymptomatic hyperuricemia for the prevention of gouty arthritis, renal disease, and cardiovascular events: a systematic literature review.
作者信息
Vinik Ophir, Wechalekar Mihir D, Falzon Louise, Buchbinder Rachelle, van der Heijde Désirée M, Bombardier Claire
机构信息
From the Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology Research Unit, Repatriation General Hospital, Daw Park; Flinders University, Bedford Park, South Australia, Australia; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; and Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada.O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; M.D. Wechalekar, MD, FRACP, Rheumatology Research Unit, Repatriation General Hospital; and Flinders University; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; R. Buchbinder, MBBS (Hons), MSc, PhD, FRACP, Director, Monash Department of Clinical Epidemiology, Cabrini Hospital, and Professor, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital.
出版信息
J Rheumatol Suppl. 2014 Sep;92:70-4. doi: 10.3899/jrheum.140465.
OBJECTIVE
To systematically review available literature on treatment of hyperuricemia (HU) as a measure of preventing gouty arthritis, renal disease, or cardiovascular events in asymptomatic patients.
METHODS
A systematic literature search was conducted in the Cochrane Library, Medline, Embase, clinical trials registries of the World Health Organization and the US National Institutes of Health, and abstracts from American College of Rheumatology/European League Against Rheumatism meetings, for interventional studies involving adults with no history of gouty arthritis, who were treated for HU. Outcomes of interest included gouty arthritis, renal disease (i.e., renal insufficiency, urate nephropathy, nephrolithiasis), and cardiovascular events (i.e., myocardial infarction, heart failure, ischemic stroke).
RESULTS
A total of 3 studies met the inclusion criteria, 2 studies assessing the prevention of renal disease and 1 study evaluating the potential for delaying progression of preexisting renal disease. In hyperuricemic patients without renal disease, treatment resulted in increased estimated glomerular filtration rate. In hyperuricemic patients with preexisting renal disease, treatment resulted in no significant elevation of serum creatinine over a 1-year followup. However, differences in renal function between the treatment and no-treatment groups were not statistically significant in any of the identified studies.
CONCLUSION
Very limited data are available on the treatment of HU in asymptomatic patients. There is currently insufficient empiric evidence to suggest that lowering serum uric acid level in asymptomatic patients with HU can prevent gouty arthritis, renal disease, or cardiovascular events.
目的
系统回顾关于治疗高尿酸血症（HU）作为预防无症状患者痛风性关节炎、肾脏疾病或心血管事件措施的现有文献。
方法
在Cochrane图书馆、Medline、Embase、世界卫生组织和美国国立卫生研究院的临床试验注册库以及美国风湿病学会/欧洲抗风湿病联盟会议摘要中进行系统文献检索，以查找涉及无痛风性关节炎病史的成人HU治疗的干预性研究。感兴趣的结果包括痛风性关节炎、肾脏疾病（即肾功能不全、尿酸盐肾病、肾结石）和心血管事件（即心肌梗死、心力衰竭、缺血性中风）。
结果
共有3项研究符合纳入标准，2项研究评估肾脏疾病的预防，1项研究评估延缓现有肾脏疾病进展的可能性。在无肾脏疾病的高尿酸血症患者中，治疗导致估计肾小球滤过率增加。在已有肾脏疾病的高尿酸血症患者中，治疗在1年随访期间未导致血清肌酐显著升高。然而，在任何已识别的研究中，治疗组和未治疗组之间的肾功能差异均无统计学意义。
结论
关于无症状患者HU治疗的数据非常有限。目前尚无足够的经验证据表明，降低无症状HU患者的血清尿酸水平可预防痛风性关节炎、肾脏疾病或心血管事件。
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