高尿酸血症与冠心病研究进展

Progress in the research of hyperuricemia and coronary heart diseases

多项流行病学和临床研究显示高尿酸血症是冠心病发病和不良预后的独立危险因素，高尿酸可能是促进冠状动脉粥样硬化（AS）发生发展的重要因素，降尿酸治疗可改善冠心病心肌缺血，因此，高尿酸有可能成为治疗AS的新靶点。但是，仍有部分临床研究得出不同结论，认为高尿酸血症与冠心病的发病无关，尿酸的致病性仍证据不足。此外，病理研究发现人群AS斑块中存在高浓度的尿酸；体外实验发现尿酸促进内皮细胞和平滑肌细胞活性氧的生成，损伤内皮细胞功能，促进平滑肌细胞增殖，可能参与AS的形成；但是也有研究显示尿酸具有抗氧化作用。因此，尿酸与冠心病的关系仍存在争议。

A number of epidemiological studies and clinical trials had shown that hyperuricemia was an independent risk factor for morbidity and unfavorable prognosis of coronary heart diseases, and it also might contribute to the incidence and development of coronary atherosclerosis （AS）; and thus, uric acid lowering drugs had anti-ischemic effects in myocardial ischemia. Therefore, treating hyperuricemia would be a new target to prevent coronary AS. However, some other studies had obtained different conclusions revealing there was no correlation between hyperuricemia and coronary heart disease. Thus, pathogenicity of uric acid was still lack of evidence. Meanwhile, high levels of uric acid were found in atherosclerosis plaque in pathological studies. In some in vitro studies, uric acid induced reactive oxygen species production in endothelial cells and vascular smooth muscle cells （VSMCs）, which led to endothelial dysfunction and proliferation of VSMCs, and contributed to the formation of AS. However, uric acid was also proved as antioxidant in some other studies. Therefore, the relationship between hyperuricemia and coronary heart disease was still controversial.