Hisatome Ichiro
Yonago Medical Center.
No Shinkei Geka. 2024 Nov;52(6):1167-1178. doi: 10.11477/mf.1436205033.
Hyperuricemia causes not only gout but also organ damage, such as through cerebrovascular, cardiovascular, and lifestyle-related diseases. The relationship between the serum urate(SUA)level and organ damage has recently been redefined as dysuricemia, as follows: 1)SUA level is positively associated with the occurrence of gout and intra-arterial gout(gout pattern); 2)occurrence of neurodegenerative diseases is negatively correlated with SUA level(ND pattern); and 3)the relationship between SUA level and chronic kidney disease(CKD)and cardiovascular disease(CVD)forms a J-shaped curve(CKD/CVD pattern). CVDs accompanied by dysuricemia include gout, ND, and CKD/CVD patterns; therefore, optimal SUA levels must be maintained to reduce organ damage. Thus, appropriate urate-lowering agents should be selected based on the type of hyperuricemia and prescribed for lowering the SUA levels toward the optimal value. Xanthine oxidase inhibitors are prescribed for hyperuricemic patients with renal overload and uricosuric agents for hyperuricemic patients with renal undersecretion.
高尿酸血症不仅会引发痛风，还会导致器官损伤，比如引发脑血管疾病、心血管疾病以及与生活方式相关的疾病。血清尿酸（SUA）水平与器官损伤之间的关系最近被重新定义为排尿异常血症，具体如下：1）SUA水平与痛风和动脉内痛风（痛风模式）的发生呈正相关；2）神经退行性疾病的发生与SUA水平呈负相关（ND模式）；3）SUA水平与慢性肾脏病（CKD）和心血管疾病（CVD）之间的关系呈J形曲线（CKD/CVD模式）。伴有排尿异常血症的心血管疾病包括痛风、ND和CKD/CVD模式；因此，必须维持最佳的SUA水平以减少器官损伤。因此，应根据高尿酸血症的类型选择合适的降尿酸药物，并开具处方以将SUA水平降至最佳值。对于肾脏负荷过重的高尿酸血症患者，应开具黄嘌呤氧化酶抑制剂，而对于肾脏分泌不足的高尿酸血症患者，应开具促尿酸排泄药。
