Nakamura T, Takagi K, Ueda T
Internal Medicine I, Fukui Medical School.
Nihon Rinsho. 1996 Dec;54(12):3230-6.
This paper is a review of the studies on urate metabolism of gouty patients with hyperuricemia and normal healthy subjects, performed mainly in our laboratory. The pathogenesis of hyperuricemia consisted of overproduction and underexcretion, which can be estimated using the urate clearance test. Overproduction was defined as urinary urate excretion (Uua) higher than [0.030 Cua + 0.325] mg/kg/hr and underexcretion as urate clearance (Cua) lower than 6.1 ml/min. According to those criteria, hyperuricemia was classified into the 4 types of overproduction (12%), underexcretion (60%), combined (25%) and normal type (3%). Patients with overproduction had a tendency of lower serum urate level (Sua) than those with underexcretion, higher Uua than those with the normal control and lower Cua and creatinine clearance (Ccr) than those with the normal control. Patients with underexcretion had a tendency of higher Sua and lower Cua, Ccr and Cua/Ccr ratio than those with overproduction or normal control. Patients with the combined type had the highest Sua among the 4 types, and those with the normal type had the lowest Sua. These findings indicate that each subtype of hyperuricemia has characteristic features in the urate metabolism, which are valuable for better understanding and treatment of hyperuricemia in gouty patients.
本文主要基于我们实验室的研究，对高尿酸血症痛风患者和正常健康受试者的尿酸代谢研究进行综述。高尿酸血症的发病机制包括尿酸生成过多和排泄减少，可通过尿酸清除试验进行评估。尿酸生成过多定义为尿尿酸排泄量（Uua）高于[0.030Cua + 0.325]mg/kg/hr，排泄减少定义为尿酸清除率（Cua）低于6.1ml/min。根据这些标准，高尿酸血症分为4种类型：生成过多型（12%）、排泄减少型（60%）、混合型（25%）和正常型（3%）。生成过多型患者的血清尿酸水平（Sua）往往低于排泄减少型患者，尿尿酸排泄量高于正常对照组，尿酸清除率和肌酐清除率（Ccr）低于正常对照组。排泄减少型患者的血清尿酸水平较高，尿酸清除率、肌酐清除率及尿酸清除率/肌酐清除率比值低于生成过多型或正常对照组。混合型患者的血清尿酸水平在4种类型中最高，正常型患者的血清尿酸水平最低。这些发现表明，高尿酸血症的每种亚型在尿酸代谢方面都有其特征，这对于更好地理解和治疗痛风患者的高尿酸血症具有重要价值。
