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诱发痛风的六大危险因素!

2016-12-17 李沐梓 医学界内分泌频道

痛风是一组嘌呤代谢紊乱所致的疾病,其临床特点为高尿酸血症,伴痛风性急性关节炎发作、痛风石沉积、痛风石性慢性关节炎和关节畸形,部分患者后期可累及肾脏,引起慢性间质性肾炎和尿酸性肾结石形成,严重影响患者的身体健康及生活质量[1]。诱发痛风的原因非常复杂,影响体内嘌呤水平的因素除了饮食、环境,还有生活习惯、疾病等[2]。一、性别和年龄(不同年龄、性别痛风特点比较)首先,年龄与痛风的发生和发展密切相关。痛

痛风是一组嘌呤代谢紊乱所致的疾病,其临床特点为高尿酸血症,伴痛风性急性关节炎发作、痛风石沉积、痛风石性慢性关节炎和关节畸形,部分患者后期可累及肾脏,引起慢性间质性肾炎和尿酸性肾结石形成,严重影响患者的身体健康及生活质量[1]


诱发痛风的原因非常复杂,影响体内嘌呤水平的因素除了饮食、环境,还有生活习惯、疾病等[2]


一、性别和年龄



(不同年龄、性别痛风特点比较)


首先,年龄与痛风的发生和发展密切相关。痛风多见于40岁以上的中、老年人,患病率随年龄的增加而升高。但近年来高尿酸血症和痛风的发病有年轻化的趋势。有研究显示血尿酸水平在新生儿出生时浓度最低,出生24 h后开始上升,3d后基本稳定至青春期。


另外,男性和女性青春期以后血尿酸变化规律不一致,男性青春期后血尿酸水平增长较女性更快,女性在进入更年期后血尿酸水平增长较为迅速。这可能与男性和女性体内雌激素水平差异及更年期后女性体内雌激素水平改变有关。目前大量研究证实,痛风在人群中发病有明显的性别差异,男性的发病率明显高于女性,男性的累积发病率为8.6%,其中原发性痛风占5.9%,男:女为20:1,其可能原因[3]


(1)男性饮酒频率和饮酒量明显高于女性;


(2)雄性激素可能促进肾脏尿酸重吸收,抑制肾脏对尿酸的排泄,而雌激素的作用正相反。


二、饮酒




经常饮酒的人发生痛风的风险性比不常饮酒者高,其可能原因[4]


(1)乙醇刺激人体内乳酸合成增加,乳酸又可以抑制肾脏排泄尿酸的功能;


(2)乙醇可以增加人体内嘌呤合成的速度,使其产量增加;


(3)饮酒过程中常伴食用含丰富嘌呤和蛋白的食物;


(4)某些酒类,尤其是啤酒在发酵过程中可产生大量嘌呤。


三、被动吸烟




周围人经常吸烟者发生痛风的风险性比周围人不常吸烟者要高,其原因可能是被动吸烟者对烟草中有害物质几乎没有抵抗力,进而导致有害物质对被动吸烟人群危害较大,被动吸烟可能加重机体负担,降低机体免疫力,从而增加患痛风和高尿酸血症的危险性。


四、疲劳及作息紊乱




经常感觉疲劳和作息不规律者发生痛风的危险性更高,可能因为疲劳和作息不规律是两个相关联的因素,作息不规律可以导致疲劳进一步加重,从而导致机体能量消耗殆尽、代谢产物堆积和机体内环境变化等现象,同时也会导致体内尿酸的代谢受到影响,进而增加患痛风的危险。


五、饮食不规律




饮食不规律者发生痛风的风险性更高,这是由于胰岛素分泌节奏被打乱,造成肝脏生物钟基因节律紊乱,肝脏的代谢功能恶化,使原本作为能量被消耗的物质转变为脂肪堆积到脏器周围,造成内脏肥胖。


研究显示,肥胖与高尿酸血症存在密切关系,内脏性脂肪蓄积、胰岛素抵抗和多种脂肪因子的分泌等多种危险因子参与了高尿酸血症的形成[5]


六、疾病和药物




细胞核中的核酸经过一系列的代谢过程,最后分解成尿酸,而绝大部分尿酸经过肾脏排出体外。无论是生成还是排出的过程一旦出现问题,都会导致尿酸升高。


人体的尿酸来自于细胞的新陈代谢和富嘌呤食物的摄入,所以饮食因素只是痛风的部分原因;而凡是能够导致人体细胞大量破坏的疾病,比如白血病、骨髓瘤、红细胞增多症、肌溶解、剧烈运动、肥胖、肿瘤的放疗化疗等,都可能会引起尿酸升高。


另外,肾脏疾病、代谢性酸中毒、甲减、甲旁亢,以及药物(比如利尿剂、阿司匹林、环孢素、酒精等)等,都会因影响尿酸的排泄而引起高尿酸血症。


参考资料:

[1]潘善余.痛风的病因病机及治疗浅探[J].浙江中医学院学报,2004; 28( 3) : 12.

[2]Anzai N,Enomoto A,Endou H. Renal urate handling clinical relevanceof recent advances[J]. Curr Rheum atoll Ren,2005; 7( 3) : 227-34.

[3]Yu ZM,Zhang LS,Yang LF. The investigation and analysis of hyperuri-cemia in Guangzhou area's public[J]. Acta nutr Sinica,2004; 26 ( 3 ) :201-3( In Chinese) .

[4]关宝生.痛风和高尿酸血症的人群流行病学研究及hOAT1基因变异的分子生物学研究[D]. 佳木斯;佳木斯大学硕士学位论文,2011;47-8.

[5]罗浩.肥胖与高尿酸血症的关系[J].检验医学与临床,2010;3( 5) : 457-9.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=166163, encodeId=15b8166163f9, content=吸烟可怕啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Dec 27 22:41:28 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163774, encodeId=1027163e7485, content=思路不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19061994286, createdName=1e1b1150m51(暂无匿称), createdTime=Sun Dec 18 11:15:04 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163730, encodeId=450e163e30ec, content=被动吸烟太可怕, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:25 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163729, encodeId=fed0163e293e, content=拉萨, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:12 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163728, encodeId=0269163e2805, content=被动吸烟太可怕了, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:05 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163727, encodeId=3e58163e27da, content=被动吸烟!太可怕了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:47:49 CST 2016, time=2016-12-18, status=1, ipAttribution=)]
    2016-12-27 1e128d2fm65(暂无匿称)

    吸烟可怕啊

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=166163, encodeId=15b8166163f9, content=吸烟可怕啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Dec 27 22:41:28 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163774, encodeId=1027163e7485, content=思路不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19061994286, createdName=1e1b1150m51(暂无匿称), createdTime=Sun Dec 18 11:15:04 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163730, encodeId=450e163e30ec, content=被动吸烟太可怕, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:25 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163729, encodeId=fed0163e293e, content=拉萨, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:12 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163728, encodeId=0269163e2805, content=被动吸烟太可怕了, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:05 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163727, encodeId=3e58163e27da, content=被动吸烟!太可怕了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:47:49 CST 2016, time=2016-12-18, status=1, ipAttribution=)]
    2016-12-18 1e1b1150m51(暂无匿称)

    思路不错

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=166163, encodeId=15b8166163f9, content=吸烟可怕啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Dec 27 22:41:28 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163774, encodeId=1027163e7485, content=思路不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19061994286, createdName=1e1b1150m51(暂无匿称), createdTime=Sun Dec 18 11:15:04 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163730, encodeId=450e163e30ec, content=被动吸烟太可怕, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:25 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163729, encodeId=fed0163e293e, content=拉萨, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:12 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163728, encodeId=0269163e2805, content=被动吸烟太可怕了, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:05 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163727, encodeId=3e58163e27da, content=被动吸烟!太可怕了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:47:49 CST 2016, time=2016-12-18, status=1, ipAttribution=)]
    2016-12-18 idream999999

    被动吸烟太可怕

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=166163, encodeId=15b8166163f9, content=吸烟可怕啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Dec 27 22:41:28 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163774, encodeId=1027163e7485, content=思路不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19061994286, createdName=1e1b1150m51(暂无匿称), createdTime=Sun Dec 18 11:15:04 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163730, encodeId=450e163e30ec, content=被动吸烟太可怕, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:25 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163729, encodeId=fed0163e293e, content=拉萨, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:12 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163728, encodeId=0269163e2805, content=被动吸烟太可怕了, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:05 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163727, encodeId=3e58163e27da, content=被动吸烟!太可怕了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:47:49 CST 2016, time=2016-12-18, status=1, ipAttribution=)]
    2016-12-18 idream999999

    拉萨

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=166163, encodeId=15b8166163f9, content=吸烟可怕啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Dec 27 22:41:28 CST 2016, time=2016-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163774, encodeId=1027163e7485, content=思路不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19061994286, createdName=1e1b1150m51(暂无匿称), createdTime=Sun Dec 18 11:15:04 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163730, encodeId=450e163e30ec, content=被动吸烟太可怕, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:25 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163729, encodeId=fed0163e293e, content=拉萨, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:12 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163728, encodeId=0269163e2805, content=被动吸烟太可怕了, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:48:05 CST 2016, time=2016-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=163727, encodeId=3e58163e27da, content=被动吸烟!太可怕了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dcc1664035, createdName=idream999999, createdTime=Sun Dec 18 09:47:49 CST 2016, time=2016-12-18, status=1, ipAttribution=)]
    2016-12-18 idream999999

    被动吸烟太可怕了

    0

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    2016-12-18 idream999999

    被动吸烟!太可怕了

    0

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