Asymptomatic Hyperuricemia: Impact of Ultrasonography

Thirty-five patients (23 males) with asymptomatic hyperuricemia for at least two years underwent two-dimensioal ultrasonography of knees and ankles. Urate deposits (tophi) in tendons, synovium, and other soft tissues were detected in 12 patients (34%). Increased vascularity (inflammation) was evident in 8 of these patients (23%). Tophi were more frequently found in knees than in ankles and were especially prevalent in the distal patellar tendon. The presence of tophi was unrelated to the known duration of hyperuricemia (mean, 5 years). Ultrasonography allows detection of tophi and inflammation in a third and in a fourth, respectively, of asymptomatic hyperuricemic patients.     

Uric Acid Metabolism in Patients with Primary Gout and the Metabolic Syndrome

Forty-four patients (40 males) with a mean age of 58 years were included in this pilot study. Mean serum urate concentration in patients with and without the metabolic syndrome (MS) was 8.8 mg/dL and 8.1 mg/dL, respectively. Urinary uric acid excretion was 543 mg/day/1.73m² in the former and 609 mg/day/1.73m² in the latter. Uric acid to creatinine ratio was 0.37 mg/mg in patients with the MS and 0.42 mg/mg in those without the MS. Mean serum urate increased from 8.6 mg/dL in subjects with three or more MS components to 10.3 mg/dL in those with five MS components. Serum urate was markedly lower in patients with mild MS (9 patients, 8.6 mg/dL) as compared to severe MS (10 patients, 9.2 mg/dL). In contrast, urinary uric acid to creatinine ratio was 0.42 mg/mg in patients with gout and mild MS and 0.33 mg/mg in gout patients with severe MS. Uric acid underexcretion appears to be more severe in gout patients with the MS. This disturbance appears to be related to the severity of the MS.     

Proteomic Analysis to Examine the Role of Matrix Proteins in a Gouty Tophus from a Patient with Recurrent Gout

To examine the role of matrix proteins in the formation of gouty tophus, we analyzed the crystalline components and matrix proteins in a gouty tophus from a patient with recurrent gout. Micro-area X-ray diffraction analysis and infrared spectroscopy indicated that the tophus was composed of monosodium urate monohydrate. Proteomic analysis identified 134 proteins from the tophus as matrix proteins. Many proteins relevant to inflammation and host defense were identified, and immunoglobulin was detected in all four extracted fractions (KCl, formic acid, guanidine-HCl, and ethylenediaminetetraacetic acid) and from many spots throughout a broad molecular weight range after electrophoresis. It is thought that the process of biological defense including the immunity has occurred in the gouty tophus.     

痛风及高尿酸血症动物模型的研究现状和评价

痛风是一种以血尿酸增高为特征的代谢性疾病 ,近年来随着我国人民生活水平的提高 ,高尿酸血症和痛风的发病率逐年上升 ,因而研制防治痛风和高尿酸血症的药物已成为当前医药界研究的热点 ,但实验动物模型的困难严重地影响着研究工作的开展。本文对目前常见的痛风和高尿酸血症实验动物模型进行了较系统的简介 ,并根据笔者的研究经验进行了简要评价 ,供致力于该方面研究的学者参考。     

Hyperuricemia and gout are associated with cancer incidence and mortality: A meta-analysis based on cohort studies

The association between hyperuricemia or gout and cancer risk has been investigated in various published studies, but their results are conflicting. We conducted a meta-analysis to investigate whether hyperuricemia or gout was associated with the cancer incidence and mortality. Linear and nonlinear trend analyses were conducted to explore the dose–response association between them. The pooled relative risk (RR) and 95% confidence interval (CI) were used to evaluate cancer risk. A total of 24 articles (33 independent studies) were eligible for inclusion. When compared participants with the highest SUA (hyperuricemia) levels and those with the lowest SUA levels, the pooled RR was 1.08 (95% CI, 1.04–1.12), it was significantly associated among males but not among females (males, RR = 1.07; 95% CI, 1.03–1.11; females, RR = 1.06; 95% CI, 0.96–1.17). Hyperuricemia increased total cancer mortality (RR = 1.15; 95% CI, 1.05–1.26), but a significant association was observed in females rather than in males (females: RR = 1.26; 95% CI, 1.09–1.45; males, RR = 1.02; 95% CI, 0.80–1.30). Linear relationships of SUA levels with overall cancer incidence (p for nonlinearity = 0.238) and overall cancer mortality (p for nonlinearity = 0.263) were identified. However, 1 mg/dL increment in SUA levels was weakly significant in overall cancer incidence (RR = 1.01; 95% CI, 1.01–1.01) but not associated with overall cancer mortality (RR = 1.01; 95% CI, 0.99–1.03). Gout was significantly associated with increased cancer incidence (RR = 1.19; 95% CI, 1.12–1.25). In conclusion, Hyperuricemia or gout was associated with higher cancer incidence and mortality. Though a potential linear relationship between them was found, we'd better treat this result with caution.     

Relationship Between Hyperuricemia and Chronic Kidney Disease

Because approximately 70% of uric acid is excreted from the kidney, hyperuricemia occurs when renal function deteriorates. Until now, it has not been clear if the hyperuricemia seen in such renal diseases plays a role in the progression of renal disease. However, recent clinical studies show that the serum uric acid value is closely associated with hypertension in hyperuricemic patients (cross-sectional study), and also with the onset of hypertension (longitudinal study). Furthermore, one interesting report shows that treatment of hyperuricemia with allopurinol lowers blood pressure in juvenile essential hypertension patients with hyperuricemia. In addition, it is well known that hyperuricemia is closely associated with chronic kidney disease (CKD), is a risk factor for renal insufficiency in general populations, and is a poor prognostic factor of renal function in patients who also have IgA nephropathy. On the other hand, in intervention studies on hyperuricemia, the treatment of hyperuricemia with allopurinol in CKD has resulted in a fall in blood pressure and inhibition of the progression of renal damage. Conversely, the cessation of allopurinol treatment in CKD was followed by a rise in blood pressure and the development of renal damage. Furthermore, the rise of blood pressure and development of renal damage following cessation of allopurinol treatment are only seen in patients not receiving angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). This suggests that the renin angiotensin (RA) system plays an important role in the development of hypertension and renal damage from hyperuricemia.     

非布司他对痛风合并高尿酸血症患者血清sICAM-1, ET-1 及尿酸水平的影响

目的:探讨非布司他对痛风合并高尿酸血症患者血清内皮素-1(ET-1)、细胞间粘附分子-1(ICAM-1)及尿酸水平的影响。方法:收集在我院就诊或住院治疗的80例痛风合并高尿酸血症患者,随机分为实验组和对照组,每组40例。对照组患者给予别嘌呤醇片治疗;实验组患者给予非布司他片治疗。观察并比较两组患者治疗前后血尿酸、s ICAM-1、ET-1水平及临床疗效。结果:与治疗前相比,两组患者治疗后的血尿酸、s ICAM-1、ET-1水平均显著降低(P0.05);与对照组相比,实验组患者的血尿酸、s ICAM-1、ET-1水平较低(P0.05),临床治疗总有效率较高(P0.05)。结论:非布司他能够降低痛风合并高尿酸血症的s ICAM-1、ET-1及尿酸水平,且临床疗效较好。     

Roles of fat body trophocytes,mycetocytes and urocytes in the American cockroach,Periplaneta americana under starvation conditions: An ultrastructural study

In insects, trophocytes (adipocytes) are major cells of a storage organ, the fat body, from which stored glycogen and lipids are mobilized under starvation. However, cockroaches have 2 additional types of cell in the fat body: mycetocytes harboring an endosymbiont, Blattabacterium cuenoti, and urocytes depositing uric acid in urate vacuoles. These cells have not been investigated in terms of their roles under starvation conditions. To gain insight into the roles of trophocytes, mycetocytes and urocytes in cockroaches, structural changes were first investigated in the cells associated with starvation in the American cockroach, Periplaneta americana, by light and electron microscopy. The area of lipid droplets in trophocytes, the endosymbiont population and mitotic activity in mycetocytes, and the area of urate vacuoles in urocytes were analyzed in association with survival rates of the starved cockroaches. After 2 weeks of starvation, trophocytes lost glycogen rosettes and their area of lipid droplets decreased, but almost all cockroaches survived this period. However, further starvation did not reduce the area, but the survival rates dropped rapidly and all cockroaches died in 7 weeks. Endosymbionts were not affected in terms of population size and mitotic activity, even if the cockroaches were dying. The area of urate vacuoles rapidly decreased in a week of starvation and did not recover upon further starvation. These results indicate that starved cockroaches mobilize glycogen and lipids stored in trophocytes to survive for 2 weeks and then die after the exhaustion of nutrients in these cells. Endosymbionts are not digested for the recycling of nutrients, but uric acid is reused under starvation.     

微生物参与人体尿酸的合成、分解和转运

由于人类在进化过程中缺失了尿酸酶,因此尿酸成为人类嘌呤代谢的不溶性终产物,其生成过多或排泄减少,均可导致高尿酸血症和痛风。人体中70%的尿酸经肾脏排泄,其余的30%经肠道排泄。微生物与人体尿酸的合成、分解和转运息息相关。某些微生物在调控人体微生物组、降解食物中的嘌呤类物质、参与尿酸合成与分解及调控肾－肠轴的尿酸转运中起重要作用,有望为治疗高尿酸血症和痛风提供有别于使用传统化学药物和植物药物的新方法。本文主要就人体尿酸的合成、分解与转运机制及微生物在人体尿酸的合成、分解和转运中的作用作一综述。

     

一株人肠源性高效尿酸降解菌的分离、鉴定及降尿酸条件优化

摘要 目的：肠道作为人体的重要消化器官,其内定植的微生物在尿酸合成和代谢过程中发挥着重要作用,本研究利用含尿酸靶向培养基筛选正常人群肠道内具有降尿酸功能的细菌并鉴定。方法：依据尿酸的摩尔质量制备含不同浓度尿酸的BHI培养基,液体培养基扩增并驯化肠道粪便微生物,固体培养基分离和纯化具有尿酸降解功能的细菌。挑取固体培养基上形态一致的单个菌落进行革兰氏染色和镜检,筛选出已纯化菌株,在需氧和厌氧培养条件下测定尿酸降解率,选取降解率≥50%以上的菌株为高效尿酸降解菌的候选菌株,再测定不同温度和pH值条件下的尿酸降解率,进行降尿酸条件优化。利用16S rDNA序列测定法对尿酸降解菌进行鉴定,药敏实验测定该菌对抗生素的敏感性。结果：正常人群粪便微生物中分离获得一株高效尿酸降解菌B5C,第5天需氧条件下的尿酸降解率均>50%,与初始尿酸浓度相比具有统计学意义（P＜0.05）。优化降尿酸条件后,在37℃、pH7.0时,降解率可达88.7%,经鉴定为粪肠球菌,对常见的抗生素如阿莫西林、氨苄西林和青霉素G等具有较高的敏感性。结论：本研究利用含不同尿酸浓度的靶向培养基驯化、分离和鉴定出一株人肠源性细菌,在需氧条件下也具有较高的尿酸降解率,可为今后临床降尿酸微生物制剂的开发和利用提供新的菌种资源。     

Analysis of creatinine, vanilmandelic acid, homovanillic acid and uric acid in urine by micellar electrokinetic chromatography

A simultaneous determination of vanilmandelic acid, homovanillic acid, creatinine and uric acid using capillary electrophoresis was investigated. The optimum conditions of buffer concentration, pH and surfactant concentration were studied, and high resolution was obtained using a 30 mM phosphate buffer (pH 7.0) containing 150 mM sodium dodecyl sulfate. The detection was by UV absorbance at 245 nm and the column was a fused-silica capillary of 67 cm×75 μm I.D.. The determination of these metabolites in human urine was completed within 15 min without any interferences.     

2011~2014 年体检者血压水平与血清尿酸水平的关系

目的：分析2011~2014 年我院体检者血压水平与血清尿酸(UA)水平的关系。方法：选择我院2011~2014 年2150 例体检者为 研究对象,均完成血压（SBP、DBP),心率（HR）、身高、体重指数（BMI）、空腹血糖（FPG）、高密度脂蛋白胆固醇(HDL-C) 、低密度脂 蛋白胆固醇(LDL-C) 、血清总胆固醇(TC) 、甘油三酯(TG)及UA 指标检测,并对检测结果进行分析。结果：2150 例体检人群中,高 血压为860 人,占40.0%,高血压组BMI、FPG、LDL-C、TC、TG 及UA 均明显高于非高血压组,而HDL-C 明显低于非高血压组, 比较差异具有统计学意义（P＜0.05）;多因素Logistic 回归分析显示,上述指标均为高血压的独立危险因素（P＜0.05）。结论：血压 水平的升高与UA水平具有密切联系,早期控制UA水平对预防高血压的发生具有重要意义。     

Simultaneous measurement of allantoin, uric acid, xanthine and hypoxanthine in blood by high-performance liquid chromatography

A high-performance liquid chromatographic method for determining catabolism products of nucleic acids and purines, such as oxypurines (i.e. uric acid, xanthine and hypoxanthine) and allantoin in the blood plasma of ruminants was developed. The plasma was deproteinized with 10% trichloroacetic acid. The method enabled determination of oxypurines without derivatization. Allantoin was determined after conversion with 2,4-dinitrophenylhydrazine to a hydrazone (GLX-DNPH). Separation of converted allantoin, uric acid, xanthine and hypoxanthine derivatives was carried out using two reversed-phase C₁₈ columns. The combination of pre-column derivatization and gradient elution with monitoring of the effluent at 205, 254 and 360 nm provides a simple and selective analytical tool for studying oxypurines and allantoin in plasma. The total run time of the HPLC analysis was 60 min. The recovery of the purine derivatives (i.e. oxypurines and allantoin) added to the plasma was between 95 and 106%. Purine derivatives were stable when the processed samples were stored for 7 days at −10°C. The low values of the intra-assay coefficient of variations (2.5–4.6%) and the low values of the detection limits (0.187–0.004 nmol) point to the satisfactory precision and sensitivity of the method.     

Chemometric-assisted kinetic-spectrophotometric method for simultaneous determination of ascorbic acid, uric acid, and dopamine

A chemometric-assisted kinetic spectrophotometric method has been developed for simultaneous determination of ascorbic acid (AA), uric acid (UA), and dopamine (DA). This method relies on the difference in the kinetic rates of the reactions of analytes with a common oxidizing agent, tris(1,10-phenanthroline) and iron(III) complex (ferritin, [Fe(phen)₃]³⁺) at pH 4.4. The changes in absorbance were monitored spectrophotometrically. The data obtained from the experiments were processed by chemometric methods of artificial neural network (ANN) and partial least squares (PLS). Acceptable techniques of prediction set, randomization t test, cross-validation, and Y randomization were applied for the selection of the best chemometric method. The results showed that feedforward artificial neural network (FFANN) is more efficient than the other chemometric methods. The parameters affecting the experimental conditions were optimized, and it was found that under optimal conditions Beer’s law is followed in the concentration ranges of 4.3–74.1, 4.3–78.3, and 2.0–33.0 μM for AA, UA, and DA, respectively. The proposed method was successfully applied to the determination of analytes in serum and urine samples.     

The role of energy,serine, glycine,and 1-carbon units in the cost of nitrogen excretion in mammals and birds

The efficiency with which dietary protein is used affects the nitrogen excretion by the animal and the environmental impact of animal production. Urea and uric acid are the main nitrogen excretion products resulting from amino acid catabolism in mammals and birds, respectively. Nitrogen excretion can be reduced by using low-protein diets supplemented with free amino acids to ensure that essential amino acids are not limiting performance. However, there are questions whether the capacity to synthesize certain nonessential amino acids is sufficient when low-protein diets are used. This includes glycine, which is used for uric acid synthesis. Nitrogen excretion not only implies a nitrogen and energy loss in the urine, but energy is also required to synthesize the excretion products. The objective of this study was to quantify the energy and metabolic requirements for nitrogen excretion products in the urine. The stoichiometry of reactions to synthesize urea, uric acid, allantoin, and creatinine was established using information from a publicly available database. The energy cost was at least 40.3, 60.7, 64.7, and 65.4 kJ/g excreted N for urea, uric acid, allantoin, and creatinine, respectively, of which 56, 56, 47, and 85% were retained in the excretion product. Data from a broiler study were used to carry out a flux balance analysis for nitrogen, serine, glycine, and so-called 1-carbon units. The flux balance indicated that the glycine intake was insufficient to cover the requirements for growth and uric acid excretion. The serine intake was also insufficient to cover the glycine deficiency, underlining the importance of the de novo synthesis of serine and glycine. One-carbon units are also a component of uric acid and can be synthesized from serine and glycine. There are indications that the de novo synthesis of 1-carbon units may be a “weak link” in metabolism, because of the stoichiometric dependency between the synthesized 1-carbon units and glycine. The capacity to catabolize excess 1-carbon units may be limited, especially in birds fed low-protein diets. Therefore, there may be an upper limit to the 1-carbon-to-glycine requirement ratio in relation to nutrients that supply 1-carbon units and glycine. The ratio can be reduced by increasing uric acid excretion (i.e., reducing protein deposition) or by dietary supplementation with glycine. The hypothesis that the 1-carbon-to-glycine requirement ratio should be lower than the supply ratio provides a plausible explanation for the growth reduction in low-protein diets and the positive response to the dietary glycine supply.     

妊娠期高血压患者D- 二聚体、C 反应蛋白和尿酸检测的临床意义

目的:探讨妊娠期高血压患者血浆D-二聚体、CRP和尿酸检测的临床意义。方法:检测168例妊娠期高血压孕妇血浆D-二聚体、CRP和尿酸水平,同时选择55例健康孕妇作为对照。结果:妊娠期高血压患者血浆D-二聚体、CRP和尿酸与健康孕妇相应参数比较,差异均有统计学意义(P<0.05),且均随着疾病严重程度而增加。结论:D-二聚体、CRP和尿酸测定在妊娠期高血压的早期诊断和预后判定中具有重要价值。