Rheumatology：急性痛风发作时SUA水平下降原因与全身炎症反应相关

血清尿酸（SUA）水平在急性痛风发作时下降的原因尚不明确。有观点认为SUA水平的下降与全身炎症反应（SIR）相关，因SIR可促进尿尿酸的排泄。同时亦有观点认为，急性痛风发作时SUA的下降是由痛风病情本身引起的。针对以上分歧，来自英国伍尔弗汉普顿大学临床化学系的Jenna L. Waldron等人进行了一项前瞻性研究，研究结果发表于2013年4月的《风湿病学》（Rheumatology）杂志上。研究认为，急性痛风发作时SUA水平下降原因与全身炎症反应相关。

研究纳入了30例行择期膝关节或髋关节手术的患者，评估了各自术前及术后48h的SUA和尿尿酸（UA）排泄数据（尿酸排泄分数；FEua%）。SIR病情通过术前及术后的平均血清CRP和尿微量白蛋白排泄率[白蛋白-肌酐比（ACR）]进行评估。

纳入病例的术后平均（标准差）血清CRP水平较术前明显增加[5.0（5.5）vs 116.0（81.2）mg/l；P＜0.0001]，尿ACR也表现出相似的改变[0.85（1.03）vs 2.10（2.60）mg/mmol；P=0.004]。SUA水平在术后明显降低[312（64）vs 282（82）umol/l；P=0.0033]，但FEua%并无改变[6.4（2.3）vs 7.3（3.3）%；P=0.1726]。

在血尿酸水平正常且无痛风病史的患者中，SIR与SUA水平的降低间存在相关性。SUA水平的下降并非由UA经尿排泄增加所引起。本研究结果支持SUA水平在急性痛风发作时的下降是由机体的SIR病情引起这一观点，其水平下降并非来自痛风本身的影响。

与痛风相关的拓展阅读：

• Arthritis Care Res：体重指数（BMI）越高 痛风发病率越高
• ACR 2012年会：类风湿关节炎患者可发生痛风
• AIM：低水平铅暴露也增痛风风险
• Arthritis Rheum：摄入樱桃或樱桃提取物降低痛风发作风险
• ARD：高嘌呤食物可增加五倍痛风发作风险
• Arthritis Res Ther：贫血为痛风新危险因素
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The effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on serum uric acid in patients without gout: a prospective study.
OBJECTIVE
Acute gout is associated with a decrease in serum uric acid (SUA) that is considered to be in response to acute inflammation but it may be a feature of gout itself. We, therefore, aimed to investigate the effect of the acute systemic inflammatory response (SIR) on SUA concentrations in subjects without gout.
METHODS
SUA and urinary excretion of uric acid (UA) (expressed as fractional excretion of UA; FEua%) were measured in 30 patients before and 48 h after elective knee or hip surgery. The SIR was assessed by measuring serum CRP and urine microalbumin excretion [expressed as the albumin-creatinine ratio (ACR)] before and after surgery in the same patients.
RESULTS
The mean (s.d.) serum CRP increased following surgery [5.0 (5.5) vs 116.0 (81.2) mg/l; P < 0.0001) as did urine ACR [0.85 (1.03) vs 2.10 (2.60) mg/mmol; P = 0.004]. SUA decreased following surgery [312 (64) vs 282 (82) µmol/l; P = 0.0033] but FEua% was unchanged [6.4 (2.3) vs 7.3 (3.3)%; P = 0.1726].
CONCLUSION
The SIR is associated with a decrease in SUA concentrations in normouricaemic patients without gout. The decrease in SUA concentrations is not due to increased urinary excretion of UA. This study supports the notion that the decrease in SUA during acute gout is due to the associated SIR rather than gout per se.