每天1-3杯咖啡可降低痛风风险22%,咖啡竟是降尿酸利器?

2022-06-23 Shirley MedSci原创

咖啡可以减少痛风风险,这是毋庸置疑,但是作用机制仍有谜团尚待揭开。

打工人,打工魂!

打工人每日的油耗只需要一杯咖啡……

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随着咖啡在大众间的普及,学界对咖啡的研究也如雨后春笋一般“冒”出来,尤其在心血管和肿瘤领域。痛风领域对咖啡的研究也在如火如荼的进行中,并且也有一批研究已经发表问世。

2016 年 4 月,Kyu YongPark PT 等人在 Seminars in Arthritis and Rheumatism 杂志上发表的一篇关于咖啡和血尿酸水平的系统评价和荟萃分析。

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此分析纳入了 1999 年至 2014 年间发表的 9 项研究,共包含 175,310 名受试者。荟萃分析表明,咖啡对血清尿酸(UA)有显着降低作用,降低血清 UA 所需的咖啡量存在性别差异。女性(4 - 6 杯/天)比男性( 1-3 杯/天)需要更多的咖啡来降低血尿酸水平。

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2019 年,Hyon K. Choi 等人于 Am J Clin Nutr. 上发表了关于女性喝咖啡和痛风风险的前瞻性研究。

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本次研究纳入了 26 年间的 89,433 名女性参与者咖啡的摄入量与痛风发病风险之间的关系。通过问卷每 2 - 4 年评估参与者的咖啡、不含咖啡因的咖啡、茶和总咖啡因的摄入量。

 这项针对女性的大型前瞻性研究中,发生痛风的风险随着咖啡摄入量的增加而降低。与不喝咖啡的人相比,每天喝 1 - 3 杯咖啡的人患痛风的风险降低了 22 %,喝 ≥ 4 杯咖啡的人患痛风的风险降低了 57 %。

丨为什么咖啡有降低尿酸的可能呢?这要从尿酸的生产开始说起。

如下图所示:尿酸盐生成过程(即,嘌呤降解)涉及嘌呤单核苷酸,即鸟苷酸(guanosine monophosphate, GMP)、肌苷酸(inosine monophosphate, IMP)和腺苷酸(adenosine monophosphate, AMP),最终分解为嘌呤碱基,即鸟嘌呤和次黄嘌呤。后两种化合物随后被代谢为黄嘌呤。最后一步由黄嘌呤氧化酶催化,黄嘌呤不可逆地氧化最后生成尿酸盐。

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嘌呤在人体中的相互转化和降解

如上述,黄嘌呤氧化酶在这一过程中占据着举足轻重的地位。大名鼎鼎的别嘌醇和非布司他就是通过抑制黄嘌呤氧化酶发挥其降尿酸的作用的。

我们都知道,咖啡的主要成分是咖啡因,它属于甲基黄嘌呤家族,是黄嘌呤氧化酶的竞争性抑制剂,可以通过干扰黄嘌呤氧化生成尿酸盐的过程而减少尿酸的生成。但脱咖啡因咖啡和尿酸降低之间亦有显着关联,这表明咖啡中除了咖啡因以外其他成分也可能有助于降低尿酸。

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2022 年 6 月,日本防卫医科大学和大阪大学的合团队在ACR Open Rheumatol 发布了一项最新的每周内喝咖啡天数与痛风风险的孟德尔随机化(MR)分析。

 

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此研究纳入了来自日本人群的全基因组关联研究的汇总统计数据:每周喝咖啡的天数(152,634 名受试者)、痛风(3053 例病例和 4554 名对照)和 SUA 水平(121,745 名受试者)。在考虑了多效性后,对以上人群进行了第一次MR分析,揭示了喝咖啡可以降低痛风风险:咖啡摄入量与痛风呈显着负相关(优势比 [OR] = 0.29,95% 置信区间 [95% CI]:0.16-0.51,P  = 1.9 × 10 -5)。

丨咖啡可以降低SUA受到挑战

但是,与第一个研究相矛盾的是,此研究否定了咖啡通过降低SUA水平而降低痛风的风险。研究者推测咖啡是通过影响其他与痛风发病机制相关的途径,进而干扰无症状高尿酸血症到痛风的进展。

丨一项动物实验提示了咖啡对痛风影响的其他可能方式

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咖啡提取物取自未烘焙、浅度、中度和深度烘焙咖啡的豆类以及脱咖啡因和传统咖啡,并在 25°C 和 98°C 下用水提取。给 C57BL/6 小鼠注射尿酸单钠晶体诱导痛风,并以 25、75 和 225 mg / kg 剂量的咖啡提取物及其 10 mg / kg 剂量的化学成分治疗。

结果显示:与阴性对照组相比,咖啡因可提高对疼痛的耐受度(7.79 和 5.69 对比 18.53;P < 0.05 和 P < 0.001),抑制中性粒细胞迁移(1.59 × 104 和 0.38 × 104 对比 9.47 × 104;P < 0.0001)和降低促炎细胞因子浓度(IL-1β、IL-6 和 TNF-α)。

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丨血清铁蛋白学说

此前也有理论研究认为咖啡可以干扰肠道对铁的吸收,进而降低体内的血清铁蛋白。而血清铁蛋白与血清尿酸水平呈正相关,也与痛风的发作频率正相关。但是这一结论也被相关的研究所推翻。

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丨让子弹飞一会……

纵观咖啡与痛风的研究历史,咖啡可以减少痛风风险,这是毋庸置疑的。但是具体的作用机制尚有一层神秘的面纱等待揭开。

需要注意大部分关于咖啡的研究都是使用的纯的咖啡提取液,非咖啡调味品。痛风患者在选择咖啡的时候需要注意果糖的添加。已经有许多文献表明果糖与血尿酸水平升高有关,切不可见为了喝咖啡而疯狂加果糖,捡了芝麻,丢了西瓜。

此外,考虑到咖啡因对神经和其他系统的影响,过量摄入可能造成心悸、失眠等,切不可盲目摄入过量咖啡。

参考文献:

[1]Choi HK, Curhan G. Coffee consumption and risk of incident gout in women: the Nurses' Health Study. Am J Clin Nutr. 2010;92(4):922-927. doi:10.3945/ajcn.2010.29565[2]Agoons DD, Agoons BB, Kaze AD, Komanduri S. Effect of Serum Ferritin on the Association Between Coffee Intake and Hyperuricemia Among American Women: The National Health and Nutrition Examination Survey. Cureus. 2021;13(3):e13855. Published 2021 Mar 12. doi:10.7759/cureus.13855[3]Kyu Yong Park, Hyun Jung Kim, Hyeong Sik Ahn, Sun Hee Kim, Eun Ji Park, Shin-Young Yim, Jae-Bum Jun,Effects of coffee consumption on serum uric acid: systematic review and meta-analysis,Seminars in Arthritis and Rheumatism,Volume 45, Issue 5,2016,Pages 580-586.[4]Shirai, Yuya et al. “Coffee Consumption Reduces Gout Risk Independently of Serum Uric Acid Levels: Mendelian Randomization Analyses Across Ancestry Populations.”ACR open rheumatology. 4,6 (2022): 534-539. doi:10.1002/acr2.11425

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    2023-01-27 whlxd
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    2022-06-24 6068105

    速溶咖啡可以么?

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    2022-06-23 迪迦不才3

    马上去买

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    2022-06-23 spiritnsy

    学习

    0

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