妊娠期高尿酸血症

Gestational hyperuricemia

血清尿酸(SUA)是有核细胞代谢的终产物,生理浓度的SUA对人体具有积极的作用。随着我国生活水平提高,生活方式的改变,高尿酸血症(HUA)发病率呈上升趋势,导致痛风、高血压、心血管疾病及肾脏病发病率上升。生理情况下,尿酸的生成和排泄相对稳定。在早孕期,尿酸排泄增加,SUA浓度较孕前下降;中、晚孕期由于胎儿通过羊水排泄尿酸增加,肾脏对于尿酸的清除能力降低,孕妇内环境和饮食的改变,SUA浓度逐渐增高。妊娠期SUA异常升高,常与合并的妊娠相关疾病有关,如妊娠期高血压疾病、妊娠期糖尿病(GDM)等,3者相互影响。此外,妊娠期HUA可影响胎儿生长发育,较高浓度SUA可以作为早期诊断青少年抑郁症的生物学标志物,这可能与HUA导致脑细胞内神经元DNA氧化损伤有关。妊娠期HUA的诊断应基于妊娠期SUA的动态变化,而不是单纯依照成年人HUA的诊断标准进行判断。目前临床采用的降低尿酸浓度、促进尿酸排泄和镇痛的药物,对于HUA孕妇及其胎儿均具有一定风险。因此,适当碱化尿液、多饮水、促排尿、低嘌呤饮食、控制体重、禁烟、限酒等手段,对于HUA孕妇围生期是可行、安全的预防和治疗措施。

Serum uric acid（SUA）is the end product of nuclear cell metabolism.In physiological concentration of SUA has a positive effect on human body.With the improvement of living standards and lifestyle changes of Chinese people,the incidence of hyperuricemia（HUA）has been increasing,leading to a rise in the incidence of gout,hypertension,cardiovascular disease and kidney disease.In physiological condition,the formation and excretion of uric acid are relatively stable.During the first trimester of pregnancy,uric acid excretion increases,subsequently SUA concentration decreases.During the second and third trimester of pregnancy,as the fetus excreting more uric acid through amniotic fluid,the decreasing of kidney′s ability to remove uric acid,and the changes of internal environment and diet of pregnant women,the SUA concentration gradually increases.During pregnancy,elevated SUA is often associated with multiple pregnancy-related diseases,such as hypertensive disorder complicating pregnancy,gestational diabetes mellitus（GDM）,and they interact with each other.In addition,gestational HUA can affect fetal growth and development.High concentration of SUA can be used as a biological marker for early diagnosis of adolescent depression,which may related to HUA can lead to the DNA oxidative damage of neurons.The diagnosis of gestational HUA should be based on the dynamic changes of SUA during pregnancy,rather than the diagnosis criteria of adult HUA.Present medicines to prevent the synthesis of uric acid,or promote uric acid excretion and analgesics have certain potential risks to pregnant women with gestational HUA and fetus. Therefore,appropriate alkalize urine,drinking abundant water,promoting urination,low purine diet,weight control,quitting smoking,and alcohol restriction are feasible and safe to prevent and treat HUA during perinatal period.