背景:原发性痛风的致病原因包括尿酸盐过度产生和/或肾或肾外尿酸盐排泄不足。这项研究的目的是评估痛风亚型与低嘌呤饮食(LPD)反应的相关性。
方法:这是一项单中心前瞻性临床研究。2019年至2022年访问的痛风患者,来自青岛大学附属医院山东省痛风诊疗中心,中国,根据临床亚型分为三组,所有患者均接受2周低嘌呤饮食治疗。一般特征,评估饮食前后的血清尿酸(sUA)和其他临床生化变量。
结果:共626例痛风患者(年龄41.20±13.41岁,男性98.0%)包括在内。其中,69(11.0%)为生产过剩型,428(68.37%)为排泄不足型,129(20.61%)为联合型。总的来说,LPD2周后sUA显著下降(p<0.001)。此外,收缩压(SBP),舒张压(DBP),体重指数(BMI),血清丙氨酸转氨酶(ALT),血清天冬氨酸转氨酶(AST),血清甘油三酯(TG),血清总胆固醇(TC),血尿素氮(BUN)和血清肌酐(Scr)水平低于基线(p<0.05)。另一方面,不同类型之间sUA的降低存在显着差异,排序顺序为生产过剩型(-88.81±63.01μmol/L)>复合型(-65.22±44.13μmol/L)>排泄不足型(-57.32±61.19μmol/L)。在调整了年龄之后,BMI和基线sUA和eGFR,不同类型之间的血尿酸下降仍存在显著差异。较高的基线sUA(95CI-0.285,-0.191;p<0.001)和BUN(95CI-6.751,-0.602;p<0.001)与sUA下降幅度较大相关。
结论:我们的研究结果支持低嘌呤饮食对痛风患者sUA水平的保护作用,尤其是生产过剩型。此外,LPD可以对痛风患者的血压产生有益的影响,BMI,血脂,BUN和Scr水平。在ChiCTR注册的试用注册,不。ChiCTR1900022981,2019年6月5日。
BACKGROUND: The pathogenic causes of primary gout include urate overproduction and/or renal or extra-renal urate underexcretion. The aim of this study was to evaluate the association of gout subtypes with the response to low-purine diet (LPD).
METHODS: This is a single-center prospective clinical study. Gout patients visiting from 2019 to 2022, from Shandong Gout Clinic Center at the Affiliated Hospital of Qingdao University,
China, assigned to three groups according to clinical subtypes, were enrolled and all treated with 2-week low-purine diet. General characteristics, serum uric acid (sUA) and other clinical biochemical variables before and after the diet were evaluated.
RESULTS: A total of 626 gout patients (age 41.20 ± 13.41 years, male 98.0%) were included. Of these, 69 (11.0%) were overproduction type, 428 (68.37%) were underexcretion type, and 129 (20.61%) were combined type. Overall, there was a substantial decrease in sUA after a 2-week LPD (p < 0.001). In addition, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), serum triglycerides (TG), serum total cholesterol (TC), blood urea nitrogen (BUN) and serum creatinine (Scr) levels were lower than those at baseline (p < 0.05). On the other hand, there were significant differences in the reduction of sUA among different types, the rank order being overproduction type (- 88.81 ± 63.01 μmol/L) > combined type (- 65.22 ± 44.13 μmol/L) > underexcretion type (- 57.32 ± 61.19 μmol/L). After adjusting for age, BMI and baseline sUA and eGFR, there were still significant differences in the decline of serum uric acid among different types. Higher baseline sUA (95%CI - 0.285, - 0.191; p < 0.001) and BUN (95%CI - 6.751, - 0.602; p < 0.001) were correlated with greater decrease of sUA.
CONCLUSIONS: Our findings support the protective role of low-purine diet on sUA levels in gout patients, especially overproduction type. Furthermore, LPD could exert a beneficial effect on gout patients\' blood pressure, BMI, blood lipid, BUN and Scr levels. Trial registration Registered with ChiCTR, No. ChiCTR1900022981 at 06/05/2019.