Slot O
Reumatologisk afdeling, Hvidovre Hospital, København.
Ugeskr Laeger. 1994 Apr 18;156(16):2396-401.
Uric acid is formed by catabolism of purine nucleotides. Approximately 25% is excreted through the intestines and the rest through the kidneys. A little less than 5% of the population in western industrialised countries have hyperuricaemia, primarily men and postmenopausal women. Hyperuricaemia is in most cases caused by reduced renal excretion, which may be idiopathic with otherwise normal renal function. But the condition is often associated with hypertension, nephropathy and treatment with diuretics and certain other drugs. Hyperuricaemia due to increased purine metabolism is seen in malignant haematological diseases, other conditions with increased cellular turnover and during initiation of chemotherapy in malignant diseases. Moreover hyperuricaemia is associated with some metabolic disturbances and risk factors of atherosclerotic cardiovascular disease including hypertension, overweight, insulin resistance and hyperlipidaemia. Hyperuricaemia is rarely caused by constitutional enzymatic abnormalities influencing purine metabolism. In most cases hyperuricaemia is asymptomatic. It may though be complicated by gout, urolithiasis and possibly gouty nephropathy. The risk of complications is correlated to the degree and duration of hyperuricemia. Consequently, measures to affect predisposing and associated conditions should be taken including weight reduction, physical exercise and diet guidance, treatment of hypertension and possibly changes in medication. Urate lowering drug treatment is normally not indicated in asymptomatic hyperuricaemic individuals.
尿酸由嘌呤核苷酸的分解代谢形成。约25%通过肠道排泄，其余通过肾脏排泄。在西方工业化国家，略少于5%的人口患有高尿酸血症，主要是男性和绝经后女性。在大多数情况下，高尿酸血症是由肾脏排泄减少引起的，这可能是特发性的，肾功能在其他方面正常。但这种情况通常与高血压、肾病以及使用利尿剂和某些其他药物的治疗有关。在恶性血液疾病、其他细胞更新增加的情况以及恶性疾病化疗开始期间，可见由于嘌呤代谢增加导致的高尿酸血症。此外，高尿酸血症与一些代谢紊乱以及动脉粥样硬化性心血管疾病的危险因素有关，包括高血压、超重、胰岛素抵抗和高脂血症。高尿酸血症很少由影响嘌呤代谢的先天性酶异常引起。在大多数情况下，高尿酸血症是无症状的。不过，它可能会并发痛风、尿路结石，也可能并发痛风性肾病。并发症的风险与高尿酸血症的程度和持续时间相关。因此，应采取措施改善易感因素和相关状况，包括减轻体重、体育锻炼和饮食指导、治疗高血压以及可能的药物调整。对于无症状的高尿酸血症患者，通常不建议使用降尿酸药物治疗。
