Pascual E
Sección de Reumatología, Hospital General Universitario de Alicante, Spain.
Curr Opin Rheumatol. 1994 Jul;6(4):454-8. doi: 10.1097/00002281-199407000-00018.
Due to high uric acid clearance, which occurs prior to puberty, hyperuricosuria rather than hyperuricemia may be the only clue to diagnosis of purine overproduction in children who have enzymatic defects or who develop the condition in the course of treatment of malignancies. The probable inclusion of hyperuricemia as a part of syndrome X associated with insulin resistance may help in understanding its clinical associations, including coronary artery disease. Gout, hypertension, and lead often go together; thus, perhaps we should check for lead toxicity routinely in this setting. Asymptomatic joints of patients with gout contain monosodium urate crystals, and research on the factors that determine the occurrence of clinical inflammation in this setting continues as an area of current interest. Coating of the crystals by different proteins may modify their inflammatory potential and may be an important modulating mechanism.
由于青春期前尿酸清除率较高，对于患有酶缺陷或在恶性肿瘤治疗过程中出现该病症的儿童，高尿酸尿症而非高尿酸血症可能是诊断嘌呤生成过多的唯一线索。高尿酸血症可能作为与胰岛素抵抗相关的X综合征的一部分，这或许有助于理解其临床关联，包括冠状动脉疾病。痛风、高血压和铅中毒常同时出现；因此，在这种情况下，或许我们应该常规检查铅中毒情况。痛风患者无症状关节中含有尿酸钠晶体，目前人们仍关注决定这种情况下临床炎症发生的因素的研究。不同蛋白质对晶体的包裹可能会改变其炎症潜能，这可能是一种重要的调节机制。
