体重指数对血清尿酸及肾脏对口服肌苷负荷的尿酸处理反应的影响：健康志愿者的实验性干预研究
Effect of body mass index on serum urate and renal uric acid handling responses to an oral inosine load: experimental intervention study in healthy volunteers.
作者信息
Dalbeth Nicola, Allan Jordyn, Gamble Gregory D, Horne Anne, Woodward Owen M, Stamp Lisa K, Merriman Tony R
机构信息
Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand.
Department of Physiology, University of Maryland School of Medicine, Baltimore, USA.
出版信息
Arthritis Res Ther. 2020 Nov 4;22(1):259. doi: 10.1186/s13075-020-02357-y.
BACKGROUND
High body mass index (BMI) is strongly associated with hyperuricaemia. It is unknown whether overweight and obesity influences serum urate primarily through increased urate production or reduced renal clearance of uric acid. The aim of this study was to determine the influence of BMI on the response to inosine, a purine nucleoside that functions as an intermediate in the purine salvage and degradation pathways.
METHODS
Following an overnight fast, 100 healthy participants without gout attended a study visit. Blood and urine samples were taken prior to and over 180 min after 1.5 g oral inosine. Serum urate and fractional excretion of uric acid (FEUA) were analysed according to high BMI (≥ 25 kg/m) and low/normal BMI (< 25 kg/m) groups, and according to BMI as a continuous variable.
RESULTS
Participants in the high BMI group (n = 52, mean BMI 30.8 kg/m) had higher serum urate concentrations at baseline (P = 0.002) compared to those with low/normal BMI (mean BMI 21.8 kg/m). However, the high BMI group had a smaller increase in serum urate following the inosine load (P = 0.0012). The two BMI groups had a similar FEUA at baseline (P = 0.995), but those in the high BMI group had a smaller increase in FEUA following the inosine (P = 0.0003). Similar findings were observed when analysing BMI as a continuous variable. Those with high BMI had a smaller increase in FEUA per increase in serum urate, compared to those with low BMI (P = 0.005).
CONCLUSIONS
In a fasting state, people with high BMI have elevated serum urate levels but similar FEUA values compared with those with low/normal BMI. Following a purine load, those with high BMI have an attenuated renal excretion of uric acid. These data, using an experimental method to dynamically assess human urate handling, suggest that people with high BMI have a higher renal capacity for uric acid reabsorption when fasted and following a dietary purine intake have reduced renal clearance.
TRIAL REGISTRATION
Australia and New Zealand Clinical Trials Registry, ACTRN12615001302549 , date of registration 30 November 2015.
背景
高体重指数（BMI）与高尿酸血症密切相关。超重和肥胖是否主要通过增加尿酸生成或降低肾脏对尿酸的清除来影响血清尿酸尚不清楚。本研究的目的是确定BMI对肌苷反应的影响，肌苷是一种嘌呤核苷，在嘌呤补救和降解途径中起中间体作用。
方法
100名无痛风的健康参与者在过夜禁食后参加了一项研究访问。在口服1.5g肌苷之前和之后180分钟内采集血液和尿液样本。根据高BMI（≥25kg/m）和低/正常BMI（<25kg/m）组以及将BMI作为连续变量，分析血清尿酸和尿酸分数排泄（FEUA）。
结果
高BMI组（n = 52，平均BMI 30.8kg/m）在基线时的血清尿酸浓度高于低/正常BMI组（平均BMI 21.8kg/m）（P = 0.002）。然而，高BMI组在肌苷负荷后血清尿酸的增加较小（P = 0.0012）。两组在基线时的FEUA相似（P = 0.995），但高BMI组在服用肌苷后FEUA的增加较小（P = 0.0003）。将BMI作为连续变量进行分析时也观察到类似的结果。与低BMI者相比，高BMI者每增加血清尿酸，FEUA的增加较小（P = 0.005）。
结论
在禁食状态下，高BMI者的血清尿酸水平升高，但与低/正常BMI者相比，FEUA值相似。在嘌呤负荷后，高BMI者的肾脏尿酸排泄减弱。这些数据采用实验方法动态评估人体尿酸处理情况，表明高BMI者在禁食时肾脏对尿酸的重吸收能力较高，饮食中摄入嘌呤后肾脏清除率降低。
试验注册
澳大利亚和新西兰临床试验注册中心，ACTRN12615001302549，注册日期2015年11月30日。
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