高尿酸血症课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,高尿酸血症陈育青,2019/10/25,2,1.,尿酸的排泄与高尿酸血症,2.,如何看待尿酸肾病,3.,高尿酸血症和慢性肾脏病,2019/10/25,3,新合成嘌呤,600,700mg/day,嘌呤核苷酸,嘌呤碱,尿酸池,1200mg,2/3,1/3,肾排泄,600mg/d,肠道排出,200mg/d,组织核苷酸,食物嘌呤,1/3,2/3,2019/10/25,4,?,排出减少,?,混合,?,合成增加,成年人的,高尿酸血症,排出减少占,90,2019/10/25,5,Arthritis & Rheumatism 2002,2019/10/25,6,肾对尿酸的排泄的特点,代谢综合征,DM,高血压,CKD,男性,高龄,长期用利尿剂,环孢霉素,啤酒,红肉,海鲜,2019/10/25,7,肾对尿酸的转运,1.,100%,经肾小球滤过,2.,近端肾小管的复杂处理过,程,?,S1,段,98,主动重吸收,?,S2,段主动重吸收减少，,分泌量增多，达,50,?,S3,段被动弥散入血分,泌后重吸收,40,44,?,最终随尿排出占,6,10,GFR,不是唯一影响血尿酸的因素,2019/10/25,8,M. T,. Le,et al .,NDT, 2008,肾对尿酸的转运,-,转运子的,发现,负责尿酸,50,重吸收,2019/10/25,9,JAMA. 1993;270:354-359,高尿酸血症和,肾脏对钠的重吸收,增加有关,2019/10/25,10,高胰岛素血症,和尿酸排泄分数下降有关,Am J Physiol Endocrinol Metab, 1995,Hyperinsulinemia,Normal,p,SUA (mM),303 +/- 13,304 +/- 12 0.05,UA ER(mumol/min),1.66 +/- 0.21,2.12 +/- 0.23,0.03,UA CR(ml/min),5.6 +/- 0.8,7.3 +/- 0.8,0.03,UA FE(%),4.48 +/- 0.80,6.06 +/- 0.64 =90,90GFR=60 60GFR=30 GFR=90,90GFR=60,60GFR=30 GFR30,发生率,%,26.4,11,27.8,60.7 83.3,年,HU,33.2+/-0.9 27.9+/-1.5,37.4+/-1.4,37.8+/-1.7 37.6+/-2.4,龄,LU,31.3+/-0.6 30.4+/-0.5,36.3+/-0.9,36.5+/-2.1,44.8+/-5.3,P 0.073 0.128,0.496,0. 6,0.2,990,例,IgA,肾病,高尿酸血症发生率高于普通人群,2019/10/25,33,250,300,350,400,450,500,0,1,2,Oxford score T,360.4+/-4.9,(N=481),413.8+/-12.7,(N=57),449.1+/-12.8,(N=70),Univariate Analysis,Overall: p0.001,T: p=0.002,Covariate: Age p=0.001,Gender p0.001,eGFR p0.001,M=0.002,Serum uric acid levels associate with,tubulointerstitial lesions in IgA nephropathy,A. Oxford Score,2019/10/25,34,200,250,300,350,400,450,500,0,1,2,3,4,Tubulointerstial score,Univariate Analysis,Overall: p=1.08X10,-8,TCI: p=0.005,Covariate: Age p=0.002,Gender p0.001,eGFR p=0.011,M p0.001, E p=0.923, S p=0.008,0,%:,0,;,5,0,%:,4,335.9+/-,1,5.5,(N=34),328.5+/-,6.7,(N=109),371.8+/-,1,4.9,(N=37),363.7+/-,3,1.9,(N=8),416.7+/-,4,4.7,(N=4),p,=,0,.,0,3,6,p,=,0,.,0,2,1,Serum uric acid level is associated with,tubulointerstitial lesion in IgA nephropathy with GFR=90ml/min/1.73m,2,A. Jiangs Score,2019/10/25,35,Rheumatology 2008,2019/10/25,36,Rheumatology 2008,2019/10/25,37,尿酸影响内皮功能,Oxonic acid,X,Khosla et al. KI, 2005,7 days,2019/10/25,38,尿酸导致肾损伤,6 weeks,Oxonic acid,X,J Am Soc Nephrol 13: 2888,2897, 2002,2019/10/25,39,J Am Soc Nephrol 13: 2888,2897, 2002,2019/10/25,40,高尿酸血症,慢性肾损伤,2019/10/25,41,?,无症状性高尿酸血症的治疗,?,何时开始治疗,?,单纯饮食控制是否足够,?,促尿酸排泄,/,降低合成的选择,?,尿酸的目标值,2019/10/25,42,