<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">无症状高尿酸血症,治还是不治?|指南时间</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2022-05-06</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:医学界风湿免疫频道</em></h2></div><p class="brief">无症状高尿酸血症,治还是不治?|指南时间</p><div class="rich_media_content " id="js_content" style="visibility: unset;"><section style="text-align: right;"><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2020年1月,印度糖尿病与内分泌综合学会(IDEA)发布了无症状高尿酸血症的管理共识,就一直充满争议的无症状高尿酸血症的定义和管理给出了指导建议。</span></section><section><section><section><section><section><section><section><section><section><p><br/></p></section></section></section></section></section></section></section></section><section><section><section><section><p><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">高尿酸血症的定义</span></p></section><section><section><section><section><p><br/></p><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我国高尿酸血症定义为正常嘌呤饮食下,非同日两次空腹血尿酸水平男性&gt;420μmol/L,女性&gt;360μmol/L。痛风为人们所熟知与高尿酸血症相关的疾病,没有痛风发作的高尿酸血症称为无症状高尿酸血症。</span></p><p><br/></p><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">表1&nbsp; 国内外指南不同的高尿酸血症临界值</span></p><p><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/1605273317870" style="text-align: center;"/></p><p><br/></p></section></section></section></section></section></section></section></section><p><br/></p><section><section><section><section><section><section><section><section><section><p><br/></p></section></section></section></section></section></section></section></section><section><section><section><section><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><span style="font-size: 14px; color: rgb(136, 136, 136);">建议1</span></p></section><section><section><section><section><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/1605273318016" style="text-align: center;"/></p><p><br/></p><section><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">■&nbsp;哪些人群需要筛查高尿酸血症</span></p><p><br/></p></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">(1)有急性痛风性单关节炎病史;</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">(2)有慢性痛风或痛风石病史;</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">(3)作为尿路结石治疗的必要检查;</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">(4)恶性肿瘤患者,特别是接受化疗的患者;</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">(5)正在服用可能升高血尿酸药物人群(见表1);</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">(6)慢性肾脏疾病(eGFR<60ml/min/1.73m2&nbsp;);</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">(7)心血管疾病患者;</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">(8)代谢综合征患者。</span></section><p><br/></p><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><span style="font-size: 14px; color: rgb(136, 136, 136);">表2 可能升高血尿酸的药物</span></p><p style="text-align: center;"><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/1605273318135"/></p></section></section></section></section></section></section></section><p><br/></p></section><section><section><section><section><section><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">建议2</span></p></section><section><section><section><section><p><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/1605273318239" style="text-align: center;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">■血尿酸检测注意事项</span></p><p><br/></p><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">抽血应采用在禁食一晚后的晨血,检测近期应避免酒精摄入、吸烟、剧烈运动,前一天晚上最好不要服用药物。</span></section><p><br/></p></section></section></section></section></section></section></section><p><br/></p></section><section><section><section><section><section><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><span style="line-height: 28px; color: rgb(136, 136, 136); font-size: 14px;">建议3</span></p></section><section><section><section><section><p><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/1605273318357" style="text-align: center;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">■对于有无症状高尿酸血症的慢性肾脏病(CKD)患者的干预推荐</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于出现无症状高尿酸血症的3-4期CKD患者,进行降尿酸治疗可能获益,考虑到剂量调整,以及别嘌醇可能出现的严重皮肤不良反应,非布司他是更好的选择。</span></p><p><br/></p></section></section></section></section></section></section></section><p><br/></p></section><section><section><section><section><section><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">建议4</span></p></section><section><section><section><section><p><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/1605273318481" style="text-align: center;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">■对于有无症状高尿酸血症的心血管疾病患者的干预推荐</span></p><p><br/></p><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">尽管降尿酸治疗有利于降低高血压和心血管疾病患病风险,但我们建议无症状高尿酸血症合并心血管疾病患者在获得进一步的循证证据后再开始长期降尿酸治疗(ULT)。</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2010 年发布的《无症状高尿酸血症合并心血管疾病诊治建议中国专家共识》明确指出“对无症状高尿酸血症合并多种心血管危险因素或心血管疾病时是否给予降尿酸治疗,还没有一致意见”。</span></section></section></section></section></section></section></section></section></section><section><section><section><section><section><section><section><section><section><p><br/></p></section></section></section></section></section></section></section></section><section><section><section><section><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">建议5</span></p></section><section><section><section><section><p><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/1605273318619" style="text-align: center;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">■无症状高尿酸血症患者的治疗推荐</span></p><p><br/></p><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">所有无症状高尿酸血症患者都推荐非药物治疗,控制饮食,加强锻炼。</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于肾功能正常(eGFR≥90 ml/min/1.73m2)的无症状高尿酸血症患者,当血尿酸≥9mg/天l时,推荐别嘌呤醇作为一线治疗,起始剂量建议50-100mg/d,缓慢增至达标剂量。HLA-B*58:01基因阳性者不宜使用别嘌醇。</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于CKD患者,考虑到剂量调整和别嘌呤醇可能出现严重不良反应,建议将非布司他作为一线治疗。&nbsp;起始剂量为40mg/天,缓慢增至达标剂量。</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">CKD患者在刚开始服用非布司他时,要考虑到CKD与心血管疾病的相关性。</span></section><p><br/></p></section></section></section></section></section></section></section></section><section><section><section><section><section><section><section><section><section><p><br/></p></section></section></section></section></section></section></section></section><section><section><section><section><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">建议6</span></p></section><section><section><section><section><p><img class="rich_pages" src="https://studioyszimg.yxj.org.cn/1605273318759" style="text-align: center;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">■药物干预时间推荐</span></p><p><br/></p><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">无症状高尿酸血症患者治疗目标是血尿酸&lt; 6 mg/dl(357μmol/L);血尿酸水平低于3mg/dl(178.5μmol/L)后不建议继续长期降尿酸治疗。</span></section><p><br/></p></section></section></section></section></section></section></section></section></div><!--auditorInfo-->

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