<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;">诊断高尿酸血症,成人和未成年人的标准应该一样吗?</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;">2022-03-09</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><br/></p><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">尿酸是嘌呤核苷酸代谢的终产物,在生理条件下,具有清除氧自由基,保护细胞膜,稳定血管内皮等作用。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">病理条件下,血尿酸(SUA)水平持续升高称为高尿酸血症(HUA),而HUA与痛风、高血压、糖尿病、肾病和代谢综合征等关系密切<sup style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">[1]</sup>。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">HUA不仅见于成人,近年来,HUA的发病呈明显年轻化趋势(图1)。</strong>因此,了解未成年HUA的特征及与成人之间的区别,对于预防和治疗未成年HUA有十分重要的意义。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><br/></section><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/AC14B01E017F6C2AA970017E220599D6.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 556px ; visibility: visible ;"/></p><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图1. 全球痛风流行现状。数据来源:(PMID: 29547895)</span></p><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section><section><section><p style="text-align: center;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">未成年人HUA患病情况究竟如何?</span></p></section></section></section></section></section></section><p style="text-align: center;"><br/></p><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"></section><p style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; line-height: 1.75em;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">未成年人尿酸水平及HUA患病率与成人存在明显差异。</strong></span></p><p><br/></p><section><section><section><section><section><section><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在美国<sup>[2]</sup>,针对12-17岁青少年进行的3个阶段(1966–1970,1988-1994,2007-2010年)全国健康调查结果显示:青少年HUA患病率分别为12.1%、8.6%和10.9%(HUA诊断标准参考成人:男性&gt;7.0 mg/dl,女性&gt;5.7 mg/dl)。</span></p><br/><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在日本<sup>[3]</sup>,采用7.0 mg/dl截断点(cut off point),发现9-15岁的青少年HUA患病率为8.8%。</span></p><br/><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">泰国北部<sup>[4]</sup>689名青少年(12-18岁)HUA患病率为19.6%(男性&gt;7.0 mg/dl,女性&gt;6 mg/dl)。考虑SUA水平与青少年年龄有关。</span></p><br/><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">韩国(2016-2017年)进行第七届国民健康与营养调查数据显示,1256名青少年HUA患病率为9.4%<sup>[5]</sup>[采用标准为10-11岁时SUA水平&gt;6.6 mg/dl(两性);12-18岁男性&gt;7.7 mg/dl,12-18岁女性&gt;5.7 mg/dl]。</span></p><p><br/></p></section></section></section></section></section></section><p style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">国内研究受不同地域的影响,青少年HUA患病率差别较大,部分地区明显高于成人。</strong></span></p><p style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></p><section><section><section><section><section><section><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">马美红(2017年)等对广东10446名年龄12-18岁青少年的临床资料进行了回顾性分析,男性HUA患病率为44.6%,女生为23.6%(男性&gt;7 mg/dl,女性&gt;5.8 mg/dl)。</span></p><br/><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">陈新春(2019)等对河北唐山市1039例4-15岁儿童青少年的研究显示,HUA总检出率为13.5%,其中男性为 12.3%,女性为15.0%(男性&gt;7 mg/l,女性&gt;5.9 mg/dl)。</span></p><br/><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">LU等[6]于2017-2018年在山东省开展青少年尿酸水平横断面研究,共随机抽取青少年9371人,年龄在13-19岁之间。结果SUA浓度为6.08±1.57 mg/dl,HUA患病率分别为25.4%和60.5% (SUA≥7 mg/dl和≥5.5 mg/dl);当限值为7 mg/dl时,患病率为42.3%(男性)和8.0%(女性);当限值为5.5 mg/dl时,患病率为82.1%(男性)和38.4%(女性)。</span></p></section></section></section></section></section></section><p><br/></p><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">以上研究结果表明,未成年人SUA水平波动较大,参考标准不统一。</strong>主要受不同国家、地域、种族及饮食习惯等因素的影响,选择HUA的参考标准不同,其患病率差别很大。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">目前国内,甚至全世界还没有一个明确的、公认的与年龄和性别相关的参考区间(RI),大部分研究都是参考成年人HUA的诊断标准。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">因此,某些研究结果HUA男性患病率可高于40%,我们设想一下,如果某种疾病在青少年群体中患病率高于40%,是不是有点令人恐怖,这不仅会对家庭产生影响,还会增加青少年的心理负担,更是一个严重影响社会的公共卫生健康问题。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">经以上分析发现HUA的诊断标准是参考成人,结果可信度低,有存在过度诊断的可能。如果经过年龄的校正,相信患病率应该会有所下降。</span></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;">&nbsp;</span></p><p style="text-align: center;"><span style="color: rgb(215, 0, 15); font-size: 16px; font-weight: bold; text-align: left; letter-spacing: 0.544px;">一起来看看未成年人HUA的RI研究进展</span></p><p><br/></p><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">目前指南中大多数研究将成人HUA定义为非同日正常饮食状态下,2次测得即男性成人和女性绝经后成人SUA浓度均&gt;420 µmol/L(7.0 mg/dl),女性绝经前成人SUA浓度&gt;360 µmol/L(6.0 mg/dl)。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">HUA的定义有两种类型</strong></span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">HUA的定义,可分为统计学定义与生化定义两种类型<sup style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">[7]</sup>。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">统计学定义</strong>是指SUA水平高于人群中平均值+2×标准差(SD)<sup style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">[7]</sup>,数值与P97.5接近。而<strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">生化定义</strong>是基于尿酸盐在血液中的溶解度极限的估计值<sup style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">[7]</sup>。如果高于7.0 mg/dl,尿酸盐结晶和组织沉积的风险更高,较高的浓度与高尿酸血症相关的疾病有关,如痛风和肾结石。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在青春期前后,尤其是15-18岁年龄段,男性尿酸水平呈生理性波动、升高,有时甚至会超过7.0 mg/dl,那么尿酸盐的饱和浓度是否高于7.0 mg/dl?是性激素、温度、pH值影响了尿酸盐的溶解度,还是其它原因?</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">很显然,仅仅用尿酸盐的溶解度阈值这一指标来确定HUA截断点是不合适的,生化定义还需进一步完善。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">儿童和青少年,应该有自己的标准</strong></span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">然而,对于儿童和青少年,HUA诊断主要也是参考成人标准,几十年来一直保持不变。至今也没有合适的标准来定义健康儿童以及青少年的正常尿酸水平。已经证明,从婴儿期到整个青春发育期,SUA水平逐渐升高,并且在青春期增长最快,甚至超过成人水平。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">盲目地参考成人标准,不同年龄阶段的儿童和青少年HUA的患病率可能会被低估或高估。<strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">因此,依据青春期研究数据确定的RI进行临床评估是可行的,这有助于非专业父母、家人及患者对检测结果的识别和理解。</strong></span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在这种情况下,确定各年龄组的上限,以确定每个年龄组的RI更为合适。目前权威文献对青少年HUA诊断标准是:血清尿酸水平1-12个月&gt;500 μmol/L,1-10岁&gt;320 μmol/L,11-15岁男性&gt;470 μmol/L,11-15岁女性&gt;350 μmol/L;15岁以上同成人标准<sup style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">[8]</sup>。</span></section><p><span style="color: rgb(215, 0, 15); font-size: 16px; font-weight: bold; text-align: left; letter-spacing: 0.544px;"><br/></span></p><p style="text-align: center;"><span style="color: rgb(215, 0, 15); font-size: 16px; font-weight: bold; text-align: left; letter-spacing: 0.544px;">国内外对RI有关的多个研究</span></p><p><br/></p><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">临床实验室的检测结果对循证医学至关重要,80%的医生决策基于实验室报告提供的信息。报告实验室检测结果时,RI应适合患者的人口统计学特征,以便于获得准确的临床解释。从统计学上讲,医学RI的定义范围介于P2.5-P97.5之间,代表95% “正常”人群。因此,建立儿童尿酸水平的年龄和性别特异性RI具有重要意义。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">然而,建立准确的RI是一个复杂的过程。困难在于SUA水平受生活方式,如饮食习惯,或种族、地域、体重指数等多种因素的影响,因此每个地区的RI将有所不同。为此,国内外学者一直对未成年人HUA的RI进行深入地探讨。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">1.美国:不同年龄和性别的健康人群RI不同</strong></span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">&nbsp;</strong></span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1990年,美国梅奥诊所<sup style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">[9]</sup>对500位健康人群(年龄1-22岁)血清样本中的SUA进行检测,用P2.5和P97.5的百分位数定义RI。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">因为SUA值与年龄和性别有关,将每个年龄段RI设定为百分位估计值=预测y值±1.96×SD。<strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">可见15-17岁男性的SUA的RI在4.1-7.9 mg/dl,明显高于同年龄段女性。</strong></span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">表1.不同年龄和性别健康人群SUA的RI。数据来源:美国梅奥诊所(PMID: 2314122)</span></section><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img img_loading" src="https://studioyszimg.yxj.org.cn/AC14B01E017F6C2AAB25C4104F3A3832.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; border: 1px solid rgb(238, 237, 235); background-size: 22px ; background-position: center center ; background-repeat: no-repeat ; height: 318.352px ; width: 386px ;"/></p><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">2.日本:年龄越大,SUA越高?</strong></span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">&nbsp;</strong></span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">日本<sup style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">[10]</sup>于2011年对肥胖儿童和患病儿童HUA的患病率和特征进行分析。同样,SUA参考值也是依据不同年龄和性别进行设定。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">328健康个体由6个不同年龄组构成:&lt;1岁、1-3岁、4-6岁、7-9岁、10-12岁和13-15岁,发现SUA的平均值随着年龄的增长显著增加,在13-15岁年龄组,有显著的性别差异。HUA的截断点定义为大于每个年龄组平均值+2×SD。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">随后采用设定的截断点对1687名6-15岁肥胖儿童高尿酸血症的发生率及其与代谢综合征(MetS)的关系进行分析。总共328名儿童(19.4%)被发现患有HUA,其中,29.9%(98/328)患MetS;而在在1359名无高尿酸血症的儿童中,仅 14.5%(197/1359)患MetS。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">最常见的导致HUA的疾病是胃肠炎,其次是呼吸道感染和心血管疾病。这是首次对儿童HUA进行全面研究,有助于探讨成年期HUA和生活方式相关疾病的关系。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">3.中国台湾地区:儿科HUA患者死亡风险增加</strong></span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">一项来自中国台湾地区的研究<sup style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">[11]</sup>(1997-2008年),HUA参考的标准是SUA&gt;7.0 mg/dl。13241名受试者(M/F,7454/5787),平均年龄14.3±4.9岁。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">研究发现SUA水平为6.4±2.0 mg/dl。男性SUA水平显著高于女性(分别为7.0±2.1和5.5±1.6 mg/dl,p&lt;0.001)。男性HUA总患病率也显著高于女性(48.2%vs15.9%)。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在82800/人•年的随访中,共有455例死亡,相当于一个大概的5.50/1000人•年死亡。为研究SUA水平和死亡率之间的剂量-反应关系,分组比较显示:和SUA为6.0 mg/dl的个体相比,那些SUA为6.0-8.9、9.0-11.9和≥12 mg/dl经年龄和性别调整后的HR(95%CI)分别为1.02(0.82-1.26)、1.48(1.08-2.02)和4.73(2.67-8.37)。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在对年龄、性别、糖尿病和高血压病史进行校正后,发现HUA与全因死亡率的HR为1.38(1.13-1.69,p&lt;0.001)。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">HUA与心血管疾病和肾脏疾病所导致死亡风险增加相关,HR分别为5.0(1.79-13.94;p=0.001)和11.71(3.13–43.78;p&lt;0.001)。最终认为儿科HUA患者死亡风险增加,尤其是肾脏和心血管疾病。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">HUA与心血管疾病和肾脏疾病的潜在机制尚不清楚,HUA被认为会导致内皮功能障碍,刺激血管平滑肌细胞增殖。此外,发现SUA水平与肾素-血管紧张素系统密切相关。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">HUA与血管硬化和心肌肥厚有关,两者都是心血管和肾脏疾病的重要危险因素。<strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">因为儿童和青少年是暴露于HUA的时间比成人短,尿酸是否是心血管和肾脏疾病的致病因素,或仅仅是不良预后的一个标志,仍有待确定。</strong></span></section><section><br/></section><section><section><section><section><section><section><p style="text-align: center;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">SUA的差异,可能和这些因素有关</span></p></section></section></section></section></section></section><p><br/></p><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section><ul class=" list-paddingleft-2"><li><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于&lt;10岁儿童,SUA平均水平的增加几乎与年龄呈线性关系,且与性别无关;</span></p></li></ul><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><ul class=" list-paddingleft-2"><li><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">≥10岁男孩SUA平均水平随年龄增大而继续增加,15岁时达到峰值7.8 mg/dl,然后逐渐减少。</span></p></li></ul><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><ul class=" list-paddingleft-2"><li><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">而在女性,SUA平均水平在11-13岁时达到稳定,之后开始下降(图2)。</span></p></li></ul><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><p style="padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><img class="rich_pages wxw-img" src="https://studioyszimg.yxj.org.cn/AC14B01E017F6C2AAC29ECA215D8FBEA.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 515px ; visibility: visible ;"/></p><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; line-height: 1.75em;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图2. SUA水平因年龄和性别而异。数据来源:(PMID: 23817870)</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">总的来说,与男性相比,女性SUA峰值出现得更早,更低一些。SUA峰值出现在青春期,此时性激素的释放推动了第二性征的发育。在青春期,体内的雄激素(尤其是睾酮)分泌增加。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">日本的一项研究表明,睾酮可以升高尿酸水平<sup style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">[12]</sup>。其机制如下:睾酮的分泌增加可促进肌肉合成代谢,而肌肉重量是嘌呤的主要来源。因此,睾酮的增加将导致SUA水平升高。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">此外,肌肉重量增加会导致ATP代谢增加,肌肉中会释放更多的嘌呤中间体,这会影响尿酸水平。另一方面,睾酮可以抑制尿酸的排泄,而雌激素可以促进尿酸的排泄。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">关于性别差异,另一个合理的解释是可能与较高的肾尿酸盐再吸收的遗传易感性有关。日本的一项研究表明,肾尿酸受体ABCG2在不同种族中的表达存在差异。与女性相比,男性肾脏ABCG2表达的增加可能部分解释男性中较高SUA水平。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">因此,为进一步阐明SUA水平差异的问题,基于体重、身高和Tanner青春期阶段连续变化的前瞻性研究是非常必要的。</span></section><p style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br/></p><p style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center;"><img src="https://studioyszimg.yxj.org.cn/gbcqs8159i8.png" title="" alt="" style="max-width:100%;"/></p></section><div class="footer"><div class="item"><p class="ysz-ueditor-references-label" >参考文献 <span>共12篇<i></i></span></p><div class="ysz-ueditor-references-content textLine2" lang="en"><p style="white-space: normal; padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="font-size: 16px; line-height: 28px; color: rgb(136, 136, 136);">[1]&nbsp;Pascart&nbsp;T,&nbsp; Lioté&nbsp;F. 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PMID: 31319650.</span></p><p style="white-space: normal; padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="font-size: 16px; line-height: 28px; color: rgb(136, 136, 136);">[6] Lu&nbsp;J,&nbsp; Sun&nbsp;W,&nbsp; Cui&nbsp;L,A cross-sectional study on uric acid levels among Chinese adolescents.&nbsp;Pediatr Nephrol,2020,35(3):441-446.&nbsp;PMID: 31811538.</span></p><p style="white-space: normal; padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="font-size: 16px; line-height: 28px; color: rgb(136, 136, 136);">[7] Bardin T, Richette P.&nbsp;Definition of hyperuricemia and gouty conditions.&nbsp;Curr Opin Rheumatol,2014,26(2):186-191.&nbsp;PMID:24419750.</span></p><p style="white-space: normal; padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="font-size: 16px; line-height: 28px; color: rgb(136, 136, 136);">[8] 王晶晶,毛建华.儿童高尿酸血症及相关肾损害的发生机制及临床意义.中华儿科杂志, 2016,54(09): 711-714.</span></p><p style="white-space: normal; padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="font-size: 16px; line-height: 28px; color: rgb(136, 136, 136);">[9] Burritt&nbsp;MF,&nbsp; Slockbower&nbsp;JM,&nbsp; Forsman&nbsp;RW,&nbsp; et al.Pediatric Reference Intervals for 19 Biologic Variables in Healthy Children.Mayo Clin Proc,&nbsp;1990,65(3):329-336.&nbsp;PMID: 2314122.[10] Kubota&nbsp;M,&nbsp; Nagai&nbsp;A,&nbsp; Tang&nbsp;L,et al.Investigation on hyperuricemia in children with obesity or various pediatric disorders.&nbsp;Nucleosides Nucleotides Nucleic Acids, 2011,30(12):1051-1059.PMID: 22132956.</span></p><p style="white-space: normal; padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="font-size: 16px; line-height: 28px; color: rgb(136, 136, 136);">[11]&nbsp;Hsia&nbsp;SH,&nbsp; Chou&nbsp;IJ,&nbsp; Kuo&nbsp;CF,&nbsp;et al. Survival impact of serum uric acid levels in children and adolescents. Rheumatol Int.2013, 33(11):2797-2802.&nbsp;PMID: 23817870.</span></p><p style="white-space: normal; padding: 0px; outline: 0px; max-width: 100%; min-height: 1em; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="font-size: 16px; line-height: 28px; color: rgb(136, 136, 136);">[12]&nbsp;Kurahashi H, Watanabe M, Sugimoto M, et al. Testosterone replacement elevates the serum uric acid levels in patients with female&nbsp;to male gender identity disorder. Endocr J. 2013,60:1321–1327. PMID: 24047564.</span></p><p> <br/></p></div></div>

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