Hyperuricemia (hyperuricemia, HUA)

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Summary:The diagnosis of hyperuricemia in the world is defined as: two levels of fasting SUA level on the same day of non purine diet: male



The diagnosis of hyperuricemia in the world is defined as: two levels of fasting SUA level on the same day of non purine diet: male > (mol/L), female > 360 mol/L. With the rapid development of economy, people's living standard has been greatly improved than before, diet changes, hyperuricemia ((hyperuricemia, HUA) the incidence rate in our country has gradually increased, the prevalence of age have advanced trend.... The prevalence of asymptomatic hyperuricemia in China is rising, and the incidence is gradually younger. At present, about 120 million of patients with hyperuricemia, gout patients about 17 million.

Uric acid is the end product of purine compounds. Basic research has confirmed that 90% of hyperuricemia is due to a decrease in uric acid excretion, and a correlation between increased uric acid synthesis and 10%. Gout is a group of syndromes caused by disorders of purine metabolism and / or uric acid excretion, resulting in elevated serum uric acid, and deposition of uric acid in tissues or organs from supersaturated extracellular fluid. The enhancement of purine synthesis and / or the decrease of uric acid excretion is the primary mechanism of the increase of serum uric acid in patients with gout.

Gender difference of hyperuricemia

There were significant gender differences in hyperuricemia. The incidence of hyperuricemia in men was 21.6%, while for females was about 8.6%. It is reported that the incidence of hyperuricemia in male and female is as high as 10: 1. The prevalence rate of female increased with age, and the detection rate of hyperuricemia in postmenopausal women was almost equal to that of male. The detection rate of hyperuricemia in male was higher than that of female. The first one was that the male's social intercourse and bad eating habits were more than that of female. Two. After menopause, the rate of hyperuricemia was significantly increased, which may be due to the decrease of estrogen level, which leads to the elimination of uric acid

Risk of hyperuricemia

More and more studies show that there is a close relationship between hyperuricemia and hypertension, insulin resistance, obesity, hyperlipidemia, arteriosclerosis is aggravated, and the important factors to promote the progression of cardiovascular and cerebrovascular diseases. Uric acid is a predictor of progression to type 2 diabetes in patients with diabetes risk factors. The level of serum uric acid in patients with diabetes risk factors was higher than that in normal subjects. HUA significantly increased risk of stroke and mortality. When there is diabetes, high uric acid level has more obvious influence on the incidence of vascular events. HUA is an independent predictor of adverse outcomes (death or life dependence) and high incidence of vascular events after stroke in patients with acute ischemic stroke. HUA is closely related to multiple risk factors of cerebrovascular disease, which is an important risk factor for ischemic stroke. Therefore, we should pay attention to HUA, the early treatment of a reasonable standard.

Therapeutic medication:

Xanthine oxidase inhibitor 1 inhibition of the formation of uric acid is the preferred drug, recommended allopurinol or febuxostat monotherapy. Allopurinol is a competitive inhibitor of xanthine oxidase to produce uric acid by inhibiting the synthesis of uric acid. Chronic kidney disease and the use of thiazide diuretics in patients with allopurinol, need to be alert to the possible hypersensitivity syndrome, however, a considerable proportion of hyperuricemia patients receiving allopurinol treatment can not reach the recommended control target of the concentration of serum uric acid. In addition, although the safety of allopurinol is better, but the damage in renal function in patients with adverse reaction incidence and severity were increased, so according to creatinine clearance rate cut dose. Allopurinol is often used as a first-line drug for the treatment of uric acid in a number of countries. If the single drug treatment after blood uric acid is still not standard, can be combined with oral medicine for hyperuricemia, such as a xanthine oxidase inhibitor drugs combined with a uricosuric drug use.

2 uricosuric drugs such as probenecid, benzene bromine Malone is the clinical commonly used drugs to lower uric acid. During the period of using the drugs to the water, alkaline urine and not with salicylic acid, thiazide diuretics, furosemide, a diuretic acid inhibited uric acid excretion of the drug with the same. Because of the adverse effects of these drugs on the deposition of uric acid crystals in the urinary tract, leading to renal colic, kidney stones, kidney damage, and so on, the application is limited

Note: commonly used in clinical treatment of gout drugs including Allopurinol Tablets, probenecid, benzene bromine Malone etc.. These drugs should be in the acute stage of gout after 2 weeks to start taking medication, and should be started in small dose, otherwise the blood uric acid decreased quickly, and the concentration of blood uric acid liquid joint disparity, will promote urate deposition in the synovial membrane, cartilage and articular soft tissue such as crystalline precipitates, which induce acute joint attack arthritis;

3 uric acid oxidase that catalyzes uric acid into water soluble, easily by renal excretion of allantoin, because the human body lacks the enzyme uric acid can not achieve this transformation process, thus prone to hyperuricemia or gout, supplemented by urate oxidase is another strategy for the treatment of hyperuricemia. Urate has a strong role in reducing uric acid, intravenous administration of blood uric acid can be reduced to 0, so the need for the use of corticosteroids to prevent acute gout attack. Representative drug of the enzyme (rasburicase), Pei Gloucester for enzyme (pegloticase). The latter is a kind of biological preparation, which is produced by Escherichia coli producing recombinant modified mammalian urate oxidase and methoxy polyethylene glycol. Can effectively reduce serum uric acid concentration. First approved in September 2010 in the United States for the treatment of adult patients with chronic gout who are not recommended for the control of serum uric acid levels, although traditional uric acid lowering drugs are not recommended.

4 clinical studies, single compound losartan 50 mg and hydrochlorothiazide 12.5 mg in better blood pressure but also reduce the level of uric acid, especially for patients with hyperuricemia and poor blood pressure control. The metabolism of micronized fenofibrate can effectively improve lipid and uric acid in hypertriglyceridemia and hyperuricemia patients, baseline and gender and independent of uric acid.

In recent years, there are 5 research confirmed clinical medicine of Compound Danshen dripping pills can reduce the concentration of UA, the active ingredients of tanshinone A in Salvia miltiorrhiza II can inhibit xanthine oxidase (XO) activity. The application of Shang Zaitan active ingredients of Chinese medicine in the treatment of hyperuricemia stage. Preliminary study shows that traditional Chinese medicine has the inhibition of xanthine oxidase components: Cinnamon, onion, honeysuckle, Paederiae, figwort root, cortex Fraxini, salvia, sea cucumber, corn, leaf of Toona sinensis and Radix Scutellariae, burdock root, tuckahoe, Desmodium etc.. The Chinese medicine has the role of lowering uric acid: Atractylodes rhizome, phellodendron, Wu Zhuyu, plantain, Tianjihuang, Sedum, clematis, Rhizoma Dioscoreae, Polygonum cuspidatum. Prescriptions are: five with yinehen Wuling powder, angelica Niantong pills, Ermiao pill three wonderful pills and four Miao powder etc.,. Available for clinical reference.

Diet and lifestyle change

1 a large number of drinking water: develop the habit of drinking plenty of water, or eat more fruits and foods containing water, the amount of liquid to maintain at least 2000ml/ days, the best can reach 3000ml/ days, to ensure the discharge of uric acid. Renal insufficiency, should be appropriate to limit drinking water. Uric acid excretion is also related to the pH of urine, uric acid is not conducive to uric acid excretion. Currently on the market supply of pure water pH value is generally about 6, tend to weak acidity, gout patients, this is undoubtedly a disadvantage.

2 provide enough vitamins, especially vitamin B and vitamin C.

More than and 3 to provide vegetables and fruits and other basic foods, because the body can improve the solubility of urate in the alkaline, is conducive to uric acid excretion. Other vegetables and fruits rich in vitamin C, can promote tissue urate dissolving. General requirements for daily supply of vegetables, fruit 1000g, fruit 4 ~ 5 times.

4, temperance: including liquor beer and red wine do not drink. Long term alcohol consumption can lead to increased serum uric acid and blood lactic acid in patients with gout. Can stimulate the increase in purine, drinking high purine foods often eat, wine can accelerate the metabolism of purine, resulting in increased levels of blood uric acid in the body and induce acute gouty arthritis.

5 do not eat animal organs, such as liver, kidney, brain, heart, intestine, and meat soup, eat seafood.

6 the use of low purine diet and purine content in accordance with the number of daily food can be divided into: no or very little content; content is very little (75mg/100g); high content; high content of four grades.

The content of a few Cereals, most vegetables, eggs, milk, malted milk, fruit, candy, beverage, oil etc..

The content of B (75mg/100g): Sauteed Green Beans rarely, green beans, spinach, peas, mushroom, asparagus, cauliflower, oatmeal, herring, salmon, tuna, white fish, lobster, wheat bran bread etc..

High C content: lentils, perch, pike, halibut, carp, sturgeon, shellfish, smoked ham, pork, beef, chicken, duck, goose, rabbit, dove, letinous edodes, broth, mushrooms and other visceral hepatoenteral.

The content of D is high (more than 150mg/100g), anchovies, sardines, beef liver, pancreas, brain, waist, gravy, beer, Kazakhstan crab, bone marrow.

7 pay attention to life conditioning. Hyperuricemia patients in daily life should pay attention to the spirit of excessive tension, pay attention to avoid staying up late, to develop regular habits, to quit smoking, appropriate outdoor sports. Should pay attention to weight loss, can not let too much weight.

8 pay attention to uric acid monitoring. Patients with a family history of gout should pay attention to uric acid monitoring every other month in order to prevent the development of disease. If obesity, hypertension, hyperlipidemia and other metabolic diseases, patients in the treatment of complications at the same time reduce uric acid, if necessary, drug treatment.

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