从慢性肾脏病角度看高尿酸血症与痛风的指南更新要点

Interpretation of the Major Updates of Guidelines Regarding Hyperuricemia and Gout in Chronic Kidney Disease

随着社会发展及人们生活方式的改变,高尿酸血症(HUA)与痛风的发病率显著上升,并有年轻化趋势。目前HUA已成为仅次于糖尿病的第二大代谢性疾病,其不仅是慢性肾脏病(CKD)的常见并发症,而且是导致CKD发生和发展的重要原因。基于新的研究证据,国内外有关HUA与痛风诊治指南不断更新,并提出较多新观点。本文主要从CKD角度对国内外有关HUA与痛风的指南更新要点进行解读,并结合相关研究证据从初始降尿酸治疗指征、降尿酸治疗药物的选择、痛风急性发作的管理、碱化尿液、维生素C的使用方面进行分析和探讨,旨在为临床综合性、个体化治疗提供借鉴和帮助。

The incidence of hyperuricemia(HUA)and gout is increasing significantly,and tends to occur at an early age with the social development and changes in patterns of life.HUA has become the second leading metabolic disease following diabetes mellitus,which is not only a common complication of chronic kidney disease(CKD),but also an important risk factor for CKD.The guidelines for the diagnosis and treatment of HUA and gout have been updated to accommodate newly emerging evidence.We interpreted the essentials of new updates regarding HUA and gout in CKD on the basis of research evidence,including the indication of initial urate-lowering therapy,selection of pharmacologic urate-lowering therapy,gout flare management,alkalinizing urine and use of vitamin C on the basis of research evidence,hoping to provide clinicians with supports for delivering comprehensive and individual therapies.