Chertow G M, Seifter J L, Christiansen C L, O'Donnell W J
Renal Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Clin Nephrol. 1996 Sep;46(3):193-8.
Hypouricemia has been reported in a substantial fraction of patients with AIDS and attributed to an HIV-related renal urate transport defect. We tested the alternative hypothesis that hypouricemia was associated with the administration of high-dose trimethoprim-sulfamethoxazole (TMP-SMX).
Sociodemographic, clinical, and repeated laboratory data on 45 hospitalized patients with Pneumocystis carinii pneumonia (PCP) with and without HIV infection, were abstracted by a blinded reviewer. The primary outcome of interest was the percent change in serum uric acid concentration from baseline to hospital day 5 +/- 1.
Subjects who received TMP-SMX were older (mean age 44.8 vs. 37.0, p = 0.02), less likely to be HIV-seropositive (61% vs. 94%, p = 0.01), and more likely to have received glucocorticoid therapy (75% vs. 35%, p = 0.01) than those who received pentamidine, dapsone-trimethoprim, clindamycin-primaquine, sulfadiazine-pyramethamine, or a combination of these agents. The administration of TMP-SMX was associated with a 37% +/- 12% reduction in serum uric acid concentration, adjusting for the effects of age, sex, race, HIV antibody status, renal function, serum sodium, and the use of diuretics and glucocorticoids (p = 0.005).
Among a diverse cohort of hospitalized patients with PCP, treatment with high-dose TMP-SMX was strongly associated with a reduction in serum uric acid concentration over time.
已有报道称，相当一部分艾滋病患者存在低尿酸血症，这被归因于与HIV相关的肾脏尿酸转运缺陷。我们检验了另一种假说，即低尿酸血症与大剂量甲氧苄啶-磺胺甲恶唑（TMP-SMX）的使用有关。
由一位不知情的审阅者提取45例住院的卡氏肺孢子虫肺炎（PCP）患者（有或无HIV感染）的社会人口统计学、临床和重复实验室数据。主要关注的结果是从基线到住院第5天±1天血清尿酸浓度的变化百分比。
与接受喷他脒、氨苯砜-甲氧苄啶、克林霉素-伯氨喹、磺胺嘧啶-乙胺嘧啶或这些药物组合治疗的患者相比，接受TMP-SMX治疗的患者年龄更大（平均年龄44.8岁对37.0岁，p = 0.02），HIV血清学阳性的可能性更低（61%对94%，p = 0.01），接受糖皮质激素治疗的可能性更高（75%对35%，p = 0.01）。调整年龄、性别、种族、HIV抗体状态、肾功能、血清钠以及利尿剂和糖皮质激素的使用等因素后，TMP-SMX的使用与血清尿酸浓度降低37%±12%相关（p = 0.005）。
在不同类型的住院PCP患者队列中，大剂量TMP-SMX治疗与血清尿酸浓度随时间降低密切相关。
