隐匿性高尿酸血症,危害不止是痛风!

2017-04-02 李沐梓 医学界内分泌频道

髙尿酸血症的高发年龄为中老年男性和绝经后女性,但近年来越来越趋于年轻化,已成为代谢性疾病、心血管疾病的重要危险因素。

长期以来,血尿酸是用来诊断和评价痛风患者的重要生化指标。但近年来许多研究证明,高尿酸不仅是痛风和并发肾脏损害的指标,与血管疾病及代谢性疾病也密切相关[1]。

研究证实,高尿酸血症可促进动脉硬化及血小板聚集,加速脂质在血管壁的沉积,尿酸盐可损伤动脉内膜,引起血管内皮功能障碍。据调査,我国约有高尿酸血症患者1.2亿,约占总人口的10%,需要引起医患双方的高度重视。


尿酸与冠心病

由于尿酸的物理溶解度比较低,故在血中易析出尿酸结晶,尿酸结晶被析出后附着于血管壁,直接损伤心脏冠状动脉微血管功能。尿酸结晶还可激活血小板,使血小板聚集而促进血栓形成。

另外,尿酸还有使脂质在动脉内膜沉积、促进动脉粥样硬化及斑块形成的作用,由此导致冠心病的发生与发展。调査显示,血尿酸水平≥357mmol/L时冠心病的风险就会增加。冠心病的病死率在高尿酸血症组比低尿酸血症组升高2.5倍,而女性更为显着[2]。


尿酸与高血压

尿酸通过损伤血管内皮功能,使血管舒张功能失调,血管阻力增加,血管硬化而使血压增髙。原发性高血压人群中约30%的人群伴发高尿酸血症。研究发现,血清尿酸每增加100 μmol/L,发生高血压的危险性增加23%[3]。

另一方面,高血压患者由于血压增高使肾血流量减低,致尿酸从肾小管重吸收增加,促进了高尿酸血症的发展。即高尿酸血症可致高血压,而高血压又是高尿酸血症的促发因素。


尿酸与心血管事件

大量资料证实,高尿酸血症患者心血管病的风险大大增加。

高尿酸血症不仅与冠心病、高血压密切相关,而且是许多心血管病高危致病因子,如肥胖、髙甘油三酯血症、肾脏病、胰岛素抵抗、代谢综合征等相关,血尿酸升高59.5 μmol/L,女性冠心病死亡风险增加48%,血尿酸水平>416.5 μmol/L时脑卒中风险明显升高。

高尿酸血症伴有痛风的患者,心血管事件的风险性明显增加。但尿酸对心血管事件的危害有两重性,即尿酸水平最低者或最髙者,心血管事件的发生率最高。


尿酸与心力衰竭

在心力衰竭患者中,由于肾脏缺氧缺血,使尿酸清除减少,血尿酸就会增高。高尿酸血症可影响心脏能量代谢,也是心功能下降的—个原因。因此,高尿酸血症与心力衰竭也是互相影响,互为因果的。尿酸浓度升离,心力衰竭患者的死亡率也增加。

因此对高尿酸血症患者应积极进行防治。血清尿酸的主要来源为内源性,通过调整饮食习惯、改善生活方式既可抵御外源性因素,又可调整体内对尿酸的代谢,从而使血清尿酸水平下降。

患者首先要限制摄入高嘌呤类食物,如动物内脏、红肉、不带鳞的鱼虾、蟹、豆制品、各种肉汤、奶制品等,为促进尿酸的排泄要多饮水、戒酒、限制热量,坚持体育锻炼,减轻体重,均有益于调节体内尿酸的代谢。

凡尿酸>535 μmol/L的人群,不论有无症状均应采用降尿酸药物治疗,目前常用于降血压的药物ACEI、ARB均可抑制尿酸的重吸收,有促进尿酸排泄的作用。小剂量阿司匹林和调脂药均有较强降低血尿酸水平的作用。

临床医生应通过食物和药物疗法使患者的尿液pH值维持在6.0~6.5,内服碳酸氢钠可增加尿酸的溶解度,也有益于尿酸的排出。

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    2017-04-10 春暖花开8785

    尿酸是代谢异常的表现,与心脑血管疾病密切相关。

    0

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    2017-04-03 虈亣靌

    全程参与实验,即学即用,多次实践,确保掌握所学技术。

    0

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    2017-04-02 1e10eabem79(暂无匿称)

    尿酸危害真大

    0

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    2017-04-02 ideal肿瘤医

    学习了

    0

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    2017-04-02 1ddf0692m34(暂无匿称)

    学习了,值得分享

    0