降尿酸治疗目标

（1）对于无痛风结节或肾结石的痛风患者，治疗目标为血尿酸水平降至360μmol/L以下。

（2）对于已经出现痛风结节或肾结石的患者，血尿酸水平应控制在300μmol/L以下。药物治疗应在血尿酸水平达标后维持一段时间。

（熊雪莲）

参·考·文·献

［1］De GiorgiA,Fabbian F,Pala M,etal.Uric acid:friend or foe？Uric acid and cognitive function“Gout kills more w ise men than simple”［J］.European review formedicaland pharmacological sciences,2015，19（4）：640-646.

［2］Bardin T,Richette P.Definition of hyperuricem ia and gouty conditions［J］.Currentopinion in rheumatology,2014，26（2）：186-191.

［3］Johnson RJ,Titte S,Cade JR,etal.Uric acid,evolution and prim itive cultures［J］.Sem inars in nephrology,2005，25（1）：3-8.

［4］Yu S,Yang H,Guo X,etal.Prevalence of hyperuricem ia and its correlates in rural NortheastChinese population:from lifestyle risk factors tometabolic comorbidities［J］.Clinical rheumatology,2016，35（5）：1207-1215.

［5］Ting K,Gill TK,Keen H,etal.Prevalence and associationsof goutand hyperuricaem ia:results from an Australian population-based study［J］.Internal medicine journal,2016，46（5）：566-573.

［6］Ankli B.Current epidem iology of gout［J］.Therapeutische Umschau Revue therapeutique,2016，73（3）：125-129.

［7］Wan W,Xu X,Zhao DB,et al.Polymorphisms of uric transporter proteins in the pathogenesisof gout in a Chinese Han population［J］.Genetics andmolecular research:GMR,2015，14（1）：2546-2550.

［8］Matsuo H,Yamamoto K,Nakaoka H,etal.Genome-w ide association study of clinically defined gout identifies multiple risk loci and its association w ith clinical subtypes［J］.Annalsof the rheumatic diseases,2016，75（4）：652-659.

［9］Nguyen S,ChoiHK,Lustig RH,etal.Sugar-sweetened beverages,serum uric acid,and blood pressure in adolescents［J］.The Journal of pediatrics,2009，154（6）：807-813.

［10］ChoiHK,Curhan G.Beer,liquor,and w ine consumption and serum uric acid level:the Third NationalHealth and Nutrition Exam ination Survey［J］.Arthritisand rheumatism,2004，51（6）：1023-1029.

［11］Zhang W,Sun K,Yang Y,et al.Plasma uric acid and hypertension in a Chinese community:prospective study and meta analysis［J］.Clinical chem istry,2009，55（11）：2026-2034.

［12］Sellin L,Kielstein JT,de Groot K.Hyperuricem ia-more than gout:Impact on cardiovascular risk and renal insufficiency［J］.Zeitschrift fur Rheumatologie,2015，74（4）：322-328.

［13］Yuan H,Yu C,Li X,et al.Serum Uric Acid Levels and Risk of Metabolic Syndrome:A Dose-Response Meta-Analysis of Prospective Studies［J］.The Journal of clinical endocrinology and metabolism,2015，100（11）：4198-4207.

［14］Bhole V,Choi JW,Kim SW,etal.Serum uric acid levels and the risk of type 2 diabetes:a prospective study［J］.TheAmerican journalofmedicine,2010，123（10）：957-961.

［15］Kushiyama A,Tanaka K,Hara S,etal.Linking uric acidmetabolism to dia-betic complications［J］.World journalof diabetes,2014，5（6）：787-795.

［16］Kahn R,Buse J,FerranniniE,etal.Themetabolic syndrome:time for a critical appraisal:joint statement from the American Diabetes Association and the European Association for the Study of Diabetes［J］.Diabetes care,2005，28（9）：2289-2304.

［17］BosM J,Koudstaal PJ,Hofman A,etal.Uric acid is a risk factor formyocardial infarction and stroke:the Rotterdam study［J］.Stroke,2006，37（6）：1503-1507.

［18］Chamorro A,Obach V,Cervera A,etal.Prognostic significance of uric acid serum concentration in patientsw ith acute ischem ic stroke［J］.Stroke,2002，33（4）：1048-1052.

［19］Zhang B,Gao C,Yang N,etal.Iselevated SUA associated w ith aworse outcome in young Chinese patients w ith acute cerebral ischem ic stroke？［J］.BMC neurology,2010，10：82.

［20］Llull L,Laredo C,Renu A,etal.Uric Acid Therapy Improves Clinical Outcome in women w ith acute ischem ic stroke［J］.Stroke,2015，46（8）：2162-2167.

［21］Choi HK,A l-Arfaj AM,EftekhariA,et al.Dual energy computed tomography in tophaceous gout［J］.Annals of the rheumatic diseases,2009，68（10）：1609-1612.

［22］Park KY,Kim HJ,Ahn HS,et al.Effects of coffee consumption on serum uric acid:systematic review and meta-analysis［J］.Sem inars in arthritis and rheumatism,2016，45（5）：580-586.

［23］Choi HK,Curhan G.Coffee,tea,and caffeine consumption and serum uric acid level:the third national health and nutrition exam ination survey［J］.Arthritisand rheumatism,2007，57（5）：816-821.

［24］Tsuruta Y,Kikuchi K,Tsuruta Y,etal.Febuxostat improves endothelial function in hemodialysis patients w ith hyperuricem ia:A random ized controlled study［J］.Hemodialysis international International Symposium on Home Hemodialysis,2015，19（4）：514-520.

［25］Stamp LK,Day RO,Yun J.Allopurinol hypersensitivity:investigating the cause and m inim izing the risk［J］.Nature reviews Rheumatology,2016，12（4）：235-242.

［26］Khanna D,Fitzgerald JD,Khanna PP,etal.2012American College of Rheumatology guidelines formanagementof gout.Part1:systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricem ia［J］.Arthritis care&research,2012，64（10）：1431-1446.

［27］Wurzner G,Gerster JC,Chiolero A,et al.Comparative effects of losartan and irbesartan on serum uric acid in hypertensive patientsw ith hyperuricaem iaand gout［J］.Journalof hypertension,2001，19（10）：1855-1860.

［28］Rayner BL,Trinder YA,Baines D,et al.Effect of losartan versus candesartan on uric acid,renal function,and fibrinogen in patientsw ith hypertension and hyperuricem ia associated w ith diuretics［J］.American journal of hypertension,2006，19（2）：208-213.

［29］Athyros VG,M ikhailidis DP,Liberopoulos EN,et al.Effect of statin treatmenton renal function and serum uric acid levelsand their relation to vascular events in patientsw ith coronary heart disease andmetabolic syndrome:a subgroup analysis of the GREek Atorvastatin and Coronary heart disease Evaluation（GREACE）Study［J］.Nephrology,dialysis,transplantation:official publication of the European Dialysis and Transplant Association-European RenalAssociation,2007，22（1）：118-127.

［30］Derosa G,Maffioli P,Sahebkar A.Plasma uric acid concentrations are reduced by fenofibrate:A systematic review and meta-analysis of random ized placebo-controlled trials［J］.Pharmacological research,2015，102：63-70.

［31］IwataniM,Wasada T,Iwamoto Y,etal.Insulin sensitizer and uratemetabolism［J］.Nihon rinsho Japanese journal of clinicalmedicine,2000，58（2）：430-434.

［32］YamagishiS,IshibashiY,OjimaA,etal.Linagliptin,a xanthine-based dipeptidyl peptidase-4 inhibitor,decreases serum uric acid levels in type 2 diabetic patients partly by suppressing xanthine oxidase activity［J］.International journalof cardiology,2014，176（2）：550-552.

［33］InzucchiSE,Zinman B,Wanner C,etal.SGLT-2 inhibitorsand cardiovascular risk:proposed pathways and review of ongoing outcome trials［J］.Diabetes&vascular disease research,2015，12（2）：90-100.

［34］中国医师协会心血管内科医师分会,中国医师协会循证医学专业委员会.无症状高尿酸血症合并心血管疾病诊治建议中国专家共识［J］.中国全科医学,2010，13（11）：1145-1149.